Provider Demographics
NPI:1871783258
Name:NGUYEN, TRAM DANG (OD)
Entity type:Individual
Prefix:DR
First Name:TRAM
Middle Name:DANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:(CINDY) TRAM
Other - Middle Name:NGOC
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:811 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8815
Mailing Address - Country:US
Mailing Address - Phone:972-516-0026
Mailing Address - Fax:972-516-0609
Practice Address - Street 1:811 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8815
Practice Address - Country:US
Practice Address - Phone:972-516-0026
Practice Address - Fax:972-516-0609
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7684T152W00000X
AR2593152W00000X
WI3180-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166274722Medicaid
AR49995Medicare PIN