Provider Demographics
NPI:1932386521
Name:TRAN, MYCHELE (OD)
Entity Type:Individual
Prefix:DR
First Name:MYCHELE
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PHUONG
Other - Middle Name:MYCHELE
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2615 W PIONEER PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3602
Mailing Address - Country:US
Mailing Address - Phone:972-636-8070
Mailing Address - Fax:
Practice Address - Street 1:2615 W PIONEER PKWY STE 105
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3602
Practice Address - Country:US
Practice Address - Phone:972-636-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7142T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist