Individual provider Active NPI

Myhanh T Tran, O,D.

  • Optometrist
  • Carson, CA
National Provider Identifier
1477628519
Registry record updated Apr 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12011T Issued in CA
Practice address
1752 E Carson St
Carson, CA 90745-2506
Phone
(310) 518-7016
Fax
(310) 518-7058
NPI assigned
Nov 22, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12011T CA Primary

Addresses

Primary practice location

1752 E Carson St
Carson, CA 90745-2506

Mailing address

1752 E Carson St
Carson, CA 90745-2506
Phone (310) 518-7016

Other identifiers 1

IdentifierTypeStateIssuer
SD0120110MedicaidCA

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
I20040625000573 CA Practitioner - Optometry 1557347051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12011TCAMDOptometrist
12011CAMDAcupuncturist

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302739200000",
    "number": "1477628519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1752 E CARSON ST",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907452506",
            "telephone_number": "310-518-7016",
            "fax_number": "310-518-7058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1752 E CARSON ST",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907452506",
            "telephone_number": "310-518-7016",
            "fax_number": "310-518-7058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "MYHANH",
        "middle_name": "T",
        "credential": "O,D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2011-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12011T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0120110",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson, CA

Sources for this page

Verify at the official NPI Registry.