Provider Demographics
NPI:1891838462
Name:TRAN, JULIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
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 1:1974 SAN REMO DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2626
Mailing Address - Country:US
Mailing Address - Phone:714-612-5041
Mailing Address - Fax:714-530-4446
Practice Address - Street 1:100 BREA MALL
Practice Address - Street 2:SEARS BUILDING
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5717
Practice Address - Country:US
Practice Address - Phone:714-256-7355
Practice Address - Fax:714-530-4446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11761T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117610Medicaid
CA122086OtherEYE MED VISION