Provider Demographics
NPI:1407817265
Name:PHAN, TRANG D (OD)
Entity Type:Individual
Prefix:DR
First Name:TRANG
Middle Name:D
Last Name:PHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TRANG
Other - Middle Name:D
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:518 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2117
Mailing Address - Country:US
Mailing Address - Phone:330-630-9699
Mailing Address - Fax:330-630-3206
Practice Address - Street 1:31573 RANCHO PUEBLO RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4854
Practice Address - Country:US
Practice Address - Phone:951-302-5580
Practice Address - Fax:951-302-5581
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5488152W00000X
WI21354-875152W00000X
CA34912TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000376636OtherBLUE CROSS BLUE SHEILD
OH1407817265OtherCIGNA PPO
OH2604944Medicaid
OH341572960TLOtherSUMMACARE
OHP00444080OtherRAILROAD MEDICARE
OH1407817265OtherEMERALD HEALTH
OH$$$$$$$$$001OtherMEDICAL MUTUAL
OH000000376636OtherBLUE CROSS BLUE SHEILD
OHP00444080OtherRAILROAD MEDICARE