Provider Demographics
NPI:1497896807
Name:TRAN, PHUONG T (OD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:T
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 1:3010 N 170TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2634
Mailing Address - Country:US
Mailing Address - Phone:402-763-9590
Mailing Address - Fax:402-330-1716
Practice Address - Street 1:18201 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2875
Practice Address - Country:US
Practice Address - Phone:402-330-4349
Practice Address - Fax:402-330-1716
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU84574Medicare UPIN