Individual provider Active NPI

Thomas Van Tran, O.D.

  • Optometrist
  • Beaufort, SC
National Provider Identifier
1871664904
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1239 Issued in SC
Practice address
350 Robert Smalls Pkwy
Beaufort, SC 29906-4284
Phone
(843) 522-9755
Fax
(843) 521-3085
NPI assigned
Nov 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1239 SC Primary

Addresses

Primary practice location

350 Robert Smalls Pkwy
Beaufort, SC 29906-4284

Mailing address

20 Hayek St
Beaufort, SC 29907-2068
Phone (843) 522-0613

Other identifiers 3

IdentifierTypeStateIssuer
DA9742OtherSCMEDICAID GROUP #
D12396MedicaidSC
7679OtherSCMEDICARE GROUP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20110224000596 SC Practitioner - Optometry 4789865627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

350 Robert Smalls Pkwy
Beaufort, SC 29906-4284
Phone (843) 522-9755

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1239SCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Thomasvtran, OD, PA Optometrist CurrentSince Jan 1, 2003 Accepting new patients

Locations

350 Robert Smalls Pkwy
Beaufort, SC 29906
Phone (843) 522-8687

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871664904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 HAYEK ST",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299072068",
            "telephone_number": "843-522-0613",
            "fax_number": "843-521-3085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 ROBERT SMALLS PKWY",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299064284",
            "telephone_number": "843-522-9755",
            "fax_number": "843-521-3085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "THOMAS",
        "middle_name": "VAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP #",
            "identifier": "DA9742",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D12396",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "7679",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaufort, SC

Sources for this page

Verify at the official NPI Registry.