Provider Demographics
NPI:1972276350
Name:TRAN, TAM BAO (DO)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:BAO
Last Name:TRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:29549 N WAUKEGAN RD APT 205
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-5448
Mailing Address - Country:US
Mailing Address - Phone:408-218-2594
Mailing Address - Fax:
Practice Address - Street 1:4777 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7340
Practice Address - Country:US
Practice Address - Phone:815-477-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist