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Organization
THAO NGUYEN TRAN MD SC
Active
Organization
THAO NGUYEN TRAN MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THAO NGUYEN TRAN (PHYSICIAN)
(262) 842-2358
Entity
Organization
Contact information
Practice address
2120 82ND ST, KENOSHA, WI 53143-1612
(262) 842-2358
(888) 959-8367
Mailing address
2120 82ND ST, KENOSHA, WI 53143-1612
(262) 842-2358
(888) 959-8367
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000732285
MEDICARE ID
IL
05
—
100044357
—
WI
01
—
11357585
CAQH
—
05
—
34343200
—
WI
01
—
F100110681
MEDICARE PTAN
IL
01
—
K100133001
MEDICARE PTAN GROUP WI
WI
Enumeration date
11/26/2013
Last updated
06/18/2026
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