Provider Demographics
NPI:1508504648
Name:TRAN, JENNIFER LU (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LU
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 1:824 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2014
Mailing Address - Country:US
Mailing Address - Phone:628-999-3455
Mailing Address - Fax:
Practice Address - Street 1:490 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2510
Practice Address - Country:US
Practice Address - Phone:415-514-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35399152W00000X
FLOPC6123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist