Provider Demographics
NPI:1265692826
Name:DYNAMIC EYE CARE
Entity type:Organization
Organization Name:DYNAMIC EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-553-1826
Mailing Address - Street 1:6935 ALIANTE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-5818
Mailing Address - Country:US
Mailing Address - Phone:702-685-4320
Mailing Address - Fax:702-685-4583
Practice Address - Street 1:6935 ALIANTE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-5818
Practice Address - Country:US
Practice Address - Phone:702-685-4320
Practice Address - Fax:702-685-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAV098OtherPTAN