Provider Demographics
NPI:1013103563
Name:QUACH, THUY-TRAN N (OD)
Entity Type:Individual
Prefix:
First Name:THUY-TRAN
Middle Name:N
Last Name:QUACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:THUY
Other - Middle Name:N
Other - Last Name:QUACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8815 CONROY WINDERMERE RD
Mailing Address - Street 2:#353
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3129
Mailing Address - Country:US
Mailing Address - Phone:407-876-1200
Mailing Address - Fax:407-614-8935
Practice Address - Street 1:7828 WINTER GARDEN VINELAND RD
Practice Address - Street 2:SUITE 128
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5933
Practice Address - Country:US
Practice Address - Phone:407-876-1200
Practice Address - Fax:407-614-8923
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0868Medicare UPIN