Provider Demographics
NPI:1174951206
Name:SUSAN L. TRAN, OD, INC
Entity type:Organization
Organization Name:SUSAN L. TRAN, OD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-793-7111
Mailing Address - Street 1:8748 VALLEY BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1763
Mailing Address - Country:US
Mailing Address - Phone:626-573-2020
Mailing Address - Fax:626-800-3993
Practice Address - Street 1:8748 VALLEY BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1763
Practice Address - Country:US
Practice Address - Phone:626-573-2020
Practice Address - Fax:626-800-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB208525Medicare PIN