Provider Demographics
NPI:1669785069
Name:TRAN, MAILAN (OD)
Entity type:Individual
Prefix:DR
First Name:MAILAN
Middle Name:
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 1:888 S DISNEYLAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1847
Mailing Address - Country:US
Mailing Address - Phone:562-938-9945
Mailing Address - Fax:
Practice Address - Street 1:5991 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3752
Practice Address - Country:US
Practice Address - Phone:562-938-9945
Practice Address - Fax:562-496-0433
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEB992YMedicare PIN