Individual provider Active NPI

Simon T Tran, O.D.

  • Optometrist
  • Newport News, VA
National Provider Identifier
1932395761
Registry record updated Feb 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618001714 Issued in VA
Practice address
12401 Jefferson Ave
Suite 1
Newport News, VA 23602-4311
Phone
(757) 877-0388
Fax
(757) 833-7229
NPI assigned
Sep 14, 2007
Last updated
Feb 23, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 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 0618001714 VA Primary

Addresses

Primary practice location

12401 Jefferson Ave
Suite 1
Newport News, VA 23602-4311

Mailing address

12401 Jefferson Ave
Suite 1
Newport News, VA 23602-4311
Phone (757) 877-0388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2443COMDPsychologist
0618001714VAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Gregory P. Jellenek, OD & Associates, PC Optometrist PastSince Mar 2, 2011 Accepting new patients

Organizations & group practices 2

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": "1189728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298419200000",
    "number": "1932395761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12401 JEFFERSON AVE",
            "address_2": "SUITE 1",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024311",
            "telephone_number": "757-877-0388",
            "fax_number": "757-833-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12401 JEFFERSON AVE",
            "address_2": "SUITE 1",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024311",
            "telephone_number": "757-877-0388",
            "fax_number": "757-833-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "SIMON",
        "middle_name": "T",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-14",
        "last_updated": "2011-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.