Provider Demographics
NPI:1730143967
Name:TRAN, LAWRENCE S (OD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
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:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-0767
Mailing Address - Country:US
Mailing Address - Phone:715-483-3259
Mailing Address - Fax:715-483-5136
Practice Address - Street 1:135 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-4414
Practice Address - Country:US
Practice Address - Phone:715-483-3259
Practice Address - Fax:608-571-0088
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2504152W00000X
WI2608-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN701506200Medicaid
MN410001130Medicare PIN
MN701506200Medicaid
5173080001Medicare PIN