Individual provider Active NPI

Thai Tran, O.D.

  • Optometrist
  • Costa Mesa, CA
National Provider Identifier
1669751095
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14289TLG Issued in CA
Practice address
1500 Adams Ave Ste 102
Costa Mesa, CA 92626-3864
Phone
(714) 200-3629
NPI assigned
Aug 16, 2011
Last updated
Apr 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 14289TLG CA Primary
Corneal and Contact Management Optometrist 152WC0802X 14289TLG CA
Pediatric Optometrist 152WP0200X 14289TLG CA

Addresses

Primary practice location

1500 Adams Ave Ste 102
Costa Mesa, CA 92626-3864

Mailing address

1500 Adams Ave Ste 102
Costa Mesa, CA 92626-3864
Phone (714) 617-5030

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
I20150721000608 CA Practitioner - Optometry 3779896709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1500 Adams Ave
Suite 102
Costa Mesa, CA 92626-3864
Phone (714) 617-5030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14289TLGCAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Thai Tran Optometry Corporation Optometrist CurrentSince May 30, 2018 Accepting new patients

Locations

1500 Adams Ave
Ste 102
Costa Mesa, CA 92626
Phone (714) 200-3629

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1669751095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 ADAMS AVE STE 102",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263864",
            "telephone_number": "714-617-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 ADAMS AVE STE 102",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263864",
            "telephone_number": "714-200-3629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "THAI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-16",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14289TLG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "14289TLG",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "CA",
            "license": "14289TLG",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.