Provider Demographics
NPI:1790897320
Name:TRAN, FELIPE THOAI (OD)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:THOAI
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 1:5502 SAN BERNARDO AVE
Mailing Address - Street 2:STE 100-A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3008
Mailing Address - Country:US
Mailing Address - Phone:956-712-3022
Mailing Address - Fax:956-712-3022
Practice Address - Street 1:5502 SAN BERNARDO AVE
Practice Address - Street 2:STE 100-A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3008
Practice Address - Country:US
Practice Address - Phone:956-712-3022
Practice Address - Fax:956-712-3022
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4732-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE35QOtherBLUE CROSS & BLUE SHIELD
TX742854509OtherMERCY HEALTH PLANS
TX0193195-01Medicaid
TX00804FMedicare ID - Type Unspecified
TXE35QOtherBLUE CROSS & BLUE SHIELD