Provider Demographics
NPI:1477663565
Name:KOELER, THU TRANG (OD)
Entity Type:Individual
Prefix:DR
First Name:THU
Middle Name:TRANG
Last Name:KOELER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:THU
Other - Middle Name:ANH
Other - Last Name:TRANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7601 CARSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2367
Mailing Address - Country:US
Mailing Address - Phone:714-643-2020
Mailing Address - Fax:562-377-1872
Practice Address - Street 1:7601 CARSON BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2367
Practice Address - Country:US
Practice Address - Phone:562-384-3065
Practice Address - Fax:562-377-1872
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0131220Medicaid
CASD0131220Medicaid