Provider Demographics
NPI:1942793336
Name:TRAN, JACQUELINE HIROKO (OD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HIROKO
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 1:22312 EL PASEO
Mailing Address - Street 2:STE D
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5803
Mailing Address - Country:US
Mailing Address - Phone:949-589-6171
Mailing Address - Fax:
Practice Address - Street 1:22312 EL PASEO STE D
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-5803
Practice Address - Country:US
Practice Address - Phone:495-896-1719
Practice Address - Fax:949-589-0657
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10832957-9934152W00000X
NV1015152W00000X
CA34130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist