Provider Demographics
NPI:1760533806
Name:TRAN, JACLYN HOA (OD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:HOA
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 1:427 CASSELINO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-4811
Mailing Address - Country:US
Mailing Address - Phone:408-482-5684
Mailing Address - Fax:
Practice Address - Street 1:670 NORTHRIDGE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-2014
Practice Address - Country:US
Practice Address - Phone:831-443-6090
Practice Address - Fax:831-443-6921
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11452T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91375Medicare UPIN
CASDO114520Medicare ID - Type Unspecified