Provider Demographics
NPI:1710034913
Name:TRAN, PAUL (OD, PC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W CALTON RD STE 308
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6633
Mailing Address - Country:US
Mailing Address - Phone:916-791-5967
Mailing Address - Fax:916-791-5969
Practice Address - Street 1:502 W CALTON RD STE 308
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6633
Practice Address - Country:US
Practice Address - Phone:916-791-5967
Practice Address - Fax:916-791-5969
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4722TG152WC0802X
1171290001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019176901Medicaid
TX742816274Medicare PIN
TXU37131Medicare UPIN
TX019176901Medicaid