Provider Demographics
NPI:1518519966
Name:TRAN, CHAN THANH VAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAN THANH VAN
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VAN
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:33290 CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-4810
Mailing Address - Country:US
Mailing Address - Phone:669-251-5537
Mailing Address - Fax:
Practice Address - Street 1:35825 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-3000
Practice Address - Country:US
Practice Address - Phone:440-937-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist