Provider Demographics
NPI:1730495847
Name:TRAN, SUSAN LORRAINE (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LORRAINE
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB208524Medicare PIN