Provider Demographics
NPI:1265871784
Name:TRAN, THANH QUOC (OD)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:QUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17703 SAN FELIPE BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3340
Mailing Address - Country:US
Mailing Address - Phone:832-267-4111
Mailing Address - Fax:
Practice Address - Street 1:17703 SAN FELIPE BAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-3340
Practice Address - Country:US
Practice Address - Phone:832-267-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8221T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303815YTMCMedicare PIN