Provider Demographics
NPI:1932496379
Name:TRAN, TRUNG VAN (OD)
Entity Type:Individual
Prefix:DR
First Name:TRUNG
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 1:3824 LA SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3528
Mailing Address - Country:US
Mailing Address - Phone:951-359-3377
Mailing Address - Fax:951-643-4372
Practice Address - Street 1:3824 LA SIERRA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3528
Practice Address - Country:US
Practice Address - Phone:951-359-3377
Practice Address - Fax:951-643-4372
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist