Provider Demographics
NPI:1255061560
Name:TRAN, THANH N (OD)
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:N
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NANA
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:THANH NANA TRAN
Mailing Address - Street 1:12207 NE 104TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1848
Mailing Address - Country:US
Mailing Address - Phone:206-291-0408
Mailing Address - Fax:
Practice Address - Street 1:329 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2035
Practice Address - Country:US
Practice Address - Phone:360-834-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61312629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist