Provider Demographics
NPI:1457962193
Name:TON-TRAN, TRAM (OD)
Entity Type:Individual
Prefix:DR
First Name:TRAM
Middle Name:
Last Name:TON-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 1:903 W CENTER ST STE 9
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7315
Mailing Address - Country:US
Mailing Address - Phone:209-823-1727
Mailing Address - Fax:
Practice Address - Street 1:903 W CENTER ST STE 9
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7315
Practice Address - Country:US
Practice Address - Phone:209-823-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-15
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist