# THAO NGUYEN TRAN MD SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639509789
- **Authorized official:** THAO NGUYEN TRAN (PHYSICIAN)
- **Authorized official phone:** (262) 842-2358

## Contact information

- **Practice address:** 2120 82ND ST, KENOSHA, WI 53143-1612
- **Practice address phone:** (262) 842-2358
- **Practice address fax:** (888) 959-8367
- **Mailing address:** 2120 82ND ST, KENOSHA, WI 53143-1612
- **Mailing address phone:** (262) 842-2358
- **Mailing address fax:** (888) 959-8367

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/26/2013
- **Last updated:** 06/18/2026

## 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 |