Provider Demographics
NPI:1407302276
Name:TRAN, MICHELLE (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2699 HOSTETTER RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2227
Mailing Address - Country:US
Mailing Address - Phone:408-204-2779
Mailing Address - Fax:
Practice Address - Street 1:925 BLOSSOM HILL RD
Practice Address - Street 2:#1451
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1248
Practice Address - Country:US
Practice Address - Phone:408-284-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist