Individual provider Active NPI

Phuonganh Quoc Tran, OD

  • Optometrist
  • Laguna Hills, CA
National Provider Identifier
1366426702
Registry record updated Nov 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12122T Issued in CA
Practice address
24300 Laguna Hills Mall
Laguna Hills, CA 92653-7601
Phone
(949) 380-0060
Fax
(949) 203-6366
NPI assigned
Nov 30, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12122T CA Primary

Addresses

Primary practice location

24300 Laguna Hills Mall
Laguna Hills, CA 92653-7601

Mailing address

22 Windchime
Irvine, CA 92603-0635
Phone (714) 401-2808

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
I20070112000492 CA Practitioner - Optometry 7517967649 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ramin Tayani MD IncGroup PAC ID 3274541826, 15 clinicians

Practice addresses (Care Compare)

653 Camino de Los Mares
Suite 103
San Clemente, CA 92673-2808
Phone (949) 489-2218

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12122CAMDAddiction (Substance Use Disorder) Counselor
12122TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ramin Tayani MD Inc CurrentSince Oct 1, 2014 Accepting new patients
Luxottica of America Inc Past Accepting new patients
Pasadena Hospital Association, LTD. Past Accepting new patients
Luxottica Retail North America Inc Past Accepting new patients
Vision Center LP PastSince Mar 14, 2017 Accepting new patients

Locations

25200 La Paz Rd
Ste 100
Laguna Hills, CA 92653

25200 La Paz Rd
Laguna Hills, CA 92653

653 Camino de los Mares
Ste 107
San Clemente, CA 92673
Phone (949) 489-2210

653 Camino de los Mares
Ste 103
San Clemente, CA 92673
Phone (949) 485-1333

3301 S Harbor Blvd
Ste 104
Santa Ana, CA 92704
Phone (714) 979-2021

Interoperability endpoints

  • Direct secure messaging: phuonganh.tranod.p1@direct.tayani.nextgenshare.com

Organizations & group practices 5

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": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289952000000",
    "number": "1366426702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 WINDCHIME",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926030635",
            "telephone_number": "714-401-2808",
            "fax_number": "949-203-6366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24300 LAGUNA HILLS MALL",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926537601",
            "telephone_number": "949-380-0060",
            "fax_number": "949-203-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "PHUONGANH",
        "middle_name": "QUOC",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2010-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12122T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

Verify at the official NPI Registry.