1790007052 NPI number — LINH TRAN LE OD NO 2 PA

Table of content: (NPI 1790007052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790007052 NPI number — LINH TRAN LE OD NO 2 PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINH TRAN LE OD NO 2 PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EYE OPTIQUE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790007052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
146 WHITE CEDAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77015-1419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-398-4621
Provider Business Mailing Address Fax Number:
281-428-4702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5136 RICHMOND AVE
Provider Second Line Business Practice Location Address:
NO. 5136
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77056-6702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-398-4621
Provider Business Practice Location Address Fax Number:
281-428-4702
Provider Enumeration Date:
02/26/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
LINH
Authorized Official Middle Name:
TRAN
Authorized Official Title or Position:
DOCTOR OF OPTOMETRY
Authorized Official Telephone Number:
832-398-4621

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6447TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)