Provider Demographics
NPI:1780969832
Name:TRINH, LANA NGOC LAN (OD)
Entity type:Individual
Prefix:DR
First Name:LANA
Middle Name:NGOC LAN
Last Name:TRINH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAN
Other - Middle Name:THI
Other - Last Name:TRINH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1962 SW BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-6710
Mailing Address - Country:US
Mailing Address - Phone:503-227-0632
Mailing Address - Fax:
Practice Address - Street 1:1962 SW BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6710
Practice Address - Country:US
Practice Address - Phone:503-267-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3557ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist