Individual provider Active NPI

Michael Ngoc Tran, OD

  • Optometrist
  • San Diego, CA
National Provider Identifier
1124555172
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
33896TLG Issued in CA
Practice address
4822 Newport Ave
San Diego, CA 92107-3111
Phone
(619) 222-0559
NPI assigned
May 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 33896TLG CA Primary

Addresses

Primary practice location

4822 Newport Ave
San Diego, CA 92107-3111

Mailing address

1928 E Cortney Way
Anaheim, CA 92805-5713
Phone (714) 603-5719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181108000747 CA Practitioner - Optometry 7719231836 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newport Avenue Optometry IncGroup PAC ID 1355770058, 3 clinicians

Practice addresses (Care Compare)

4822 Newport Ave
San Diego, CA 92107-3111
Phone (619) 222-0559

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33896TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fourth Optometric Care of California Optometrist CurrentSince May 14, 2023 Accepting new patients
Newport Avenue Optometry Inc. Optometrist CurrentSince Jul 8, 2024 Accepting new patients
Fourth Optometric Care of California Optometrist Current Accepting new patients
Fourth Optometric Care of California Optometrist CurrentSince May 14, 2023 Accepting new patients

Locations

946 Manhattan Beach Blvd
Manhattan Beach, CA 90266
Phone (310) 545-4585

3333 Quality Dr
Rncho Cordova, CA 95670
Phone (704) 712-0564

4822 Newport Ave
San Diego, CA 92107
Phone (619) 222-0559

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1124555172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1928 E CORTNEY WAY",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928055713",
            "telephone_number": "714-603-5719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4822 NEWPORT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921073111",
            "telephone_number": "619-222-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "MICHAEL",
        "middle_name": "NGOC",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-20",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33896TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.