Provider Demographics
NPI:1861701385
Name:TRAN, THUY-DIEM NGO (OD)
Entity type:Individual
Prefix:DR
First Name:THUY-DIEM
Middle Name:NGO
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:THUY-DIEM
Other - Middle Name:NGUYEN
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3801 CLAIREMONT MESA BLVD.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117
Mailing Address - Country:US
Mailing Address - Phone:858-272-1051
Mailing Address - Fax:858-272-7466
Practice Address - Street 1:3801 CLAIREMONT MESA BLVD.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:858-272-1051
Practice Address - Fax:858-272-7466
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1778152W00000X
CA14292TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist