Provider Demographics
NPI:1649524216
Name:TRAN, MICHAEL DAN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4898 CONVOY ST
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1633
Mailing Address - Country:US
Mailing Address - Phone:858-565-1001
Mailing Address - Fax:858-565-1004
Practice Address - Street 1:4898 CONVOY ST
Practice Address - Street 2:STE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1633
Practice Address - Country:US
Practice Address - Phone:858-565-1001
Practice Address - Fax:858-565-1004
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist