Provider Demographics
NPI:1740253590
Name:TRAN, DIEM Q (OD)
Entity type:Individual
Prefix:
First Name:DIEM
Middle Name:Q
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1502 FOXWORTHY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1030
Mailing Address - Country:US
Mailing Address - Phone:650-814-2989
Mailing Address - Fax:206-338-0411
Practice Address - Street 1:255 MOUNT HERMON RD
Practice Address - Street 2:SUITE D
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4080
Practice Address - Country:US
Practice Address - Phone:831-438-5526
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12924T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist