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Individual

TIN T TRAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
4516 PLANK RD, FREDERICKSBURG, VA 22407-0147
(540) 371-2020
Mailing address
4516 PLANK RD, FREDERICKSBURG, VA 22407-0147
(925) 490-5599

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618003346
VA
152W00000X
Optometrist
34692TLG
CA

Other

Enumeration date
12/11/2020
Last updated
01/30/2024
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