Provider Demographics
NPI:1568438786
Name:TRAN, UT MICHAEL KHAI (OD)
Entity Type:Individual
Prefix:DR
First Name:UT MICHAEL
Middle Name:KHAI
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ELLEN RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2018
Mailing Address - Country:US
Mailing Address - Phone:717-731-1677
Mailing Address - Fax:717-761-3681
Practice Address - Street 1:3401 HARTZDALE DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7200
Practice Address - Country:US
Practice Address - Phone:717-975-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040564Medicare ID - Type Unspecified