Provider Demographics
NPI:1871664904
Name:TRAN, THOMAS VAN (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VAN
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 1:20 HAYEK ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-2068
Mailing Address - Country:US
Mailing Address - Phone:843-522-0613
Mailing Address - Fax:843-521-3085
Practice Address - Street 1:350 ROBERT SMALLS PKWY
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-4284
Practice Address - Country:US
Practice Address - Phone:843-522-9755
Practice Address - Fax:843-521-3085
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9742OtherMEDICAID GROUP #
SCD12396Medicaid
SC7679OtherMEDICARE GROUP #
SCU95827Medicare UPIN