Provider Demographics
NPI:1669629457
Name:TRAN, SHIRLEY S (OD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:S
Last Name: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 1:2529 MAIN ST
Mailing Address - Street 2:SPACE D1
Mailing Address - City:UNION GAP
Mailing Address - State:WA
Mailing Address - Zip Code:98903-1690
Mailing Address - Country:US
Mailing Address - Phone:509-248-0500
Mailing Address - Fax:
Practice Address - Street 1:2529 MAIN ST
Practice Address - Street 2:SPACE D1
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1690
Practice Address - Country:US
Practice Address - Phone:509-248-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60027079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist