Provider Demographics
NPI:1043367733
Name:TRAN, CHARLENE MY-HIEN (OD)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MY-HIEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 VICTOR CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1909
Mailing Address - Country:US
Mailing Address - Phone:408-929-8557
Mailing Address - Fax:
Practice Address - Street 1:8650 SAN YSIDRO AVE
Practice Address - Street 2:STE 104
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5267
Practice Address - Country:US
Practice Address - Phone:408-848-9922
Practice Address - Fax:408-848-9944
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215115522Medicaid
CA1215115522Medicaid