Individual provider Active NPI

Thien T Tran, OD

  • Optometrist
  • Anaheim, CA
National Provider Identifier
1376959395
Registry record updated Feb 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
15094TLG Issued in CA
Practice address
1092 N State College Blvd
Anaheim, CA 92806-2701
Phone
(714) 635-8671
Fax
(714) 635-9401
NPI assigned
Jul 10, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Low Vision Rehabilitation Optometrist 152WL0500X 15094TLG CA
Optometrist 152W00000X 15094TLG CA Primary

Addresses

Primary practice location

1092 N State College Blvd
Anaheim, CA 92806-2701

Mailing address

1092 N State College Blvd
Anaheim, CA 92806-2701
Phone (714) 635-8671

Other identifiers 1

IdentifierTypeStateIssuer
1124091-04MedicaidTX

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
I20160211001123 CA Practitioner - Optometry 9032338405 Practice locations: Anaheim, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15094CAMDProfessional Counselor
15094TLGCAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454889600000",
    "number": "1376959395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1092 N STATE COLLEGE BLVD",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928062701",
            "telephone_number": "714-635-8671",
            "fax_number": "714-635-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1092 N STATE COLLEGE BLVD",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928062701",
            "telephone_number": "714-635-8671",
            "fax_number": "714-635-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "THIEN",
        "middle_name": "T",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-10",
        "last_updated": "2016-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CA",
            "license": "15094TLG",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "15094TLG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124091-04",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.