Provider Demographics
NPI:1366607558
Name:CHI, GRACE TRAN (OD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:TRAN
Last Name:CHI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:350 S LAKE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3553
Mailing Address - Country:US
Mailing Address - Phone:626-683-6868
Mailing Address - Fax:626-782-6162
Practice Address - Street 1:350 S LAKE AVE STE 111
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-683-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3347AT152W00000X
NYTUV007297152WL0500X
CAOPT13877PLG152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation