Provider Demographics
NPI:1477576494
Name:TRAN, THUY CHU (OD)
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:CHU
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 1:4526 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1438
Mailing Address - Country:US
Mailing Address - Phone:503-284-9071
Mailing Address - Fax:506-287-6169
Practice Address - Street 1:4526 NE SANDY BOULEVARD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213
Practice Address - Country:US
Practice Address - Phone:503-284-9071
Practice Address - Fax:503-287-6169
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4009ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0059253000OtherFIRST CHOICE
OR0059253000OtherBCBS
OR069336Medicaid
ORU55166OtherBCBS, ODS, PROVIDENCE
OR5555758OtherAETNA
ORU55166OtherCIGNA
ORU55166OtherCIGNA
OR5555758OtherAETNA