Provider Demographics
NPI:1871617928
Name:THUY TRAN QUACH O D P A
Entity type:Organization
Organization Name:THUY TRAN QUACH O D P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THUY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-654-5453
Mailing Address - Street 1:8815 CONROY WINDERMERE RD
Mailing Address - Street 2:# 353
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3129
Mailing Address - Country:US
Mailing Address - Phone:407-654-5453
Mailing Address - Fax:407-654-6054
Practice Address - Street 1:3119 DANIELS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-7012
Practice Address - Country:US
Practice Address - Phone:407-654-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0868Medicare UPIN