MEDICARE: DR. TROY JOSEPH MYSLIWIEC O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618002317	VA

General Provider Information

NPI Number	:	1255743613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TROY JOSEPH MYSLIWIEC O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1789
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24008-1789
Country	:	US
Telephone Number	:	540-855-3554
Fax Number	:	540-342-4373

Provider Business Practice Location Address
First Line	:	395 S MAIN ST
Second Line	:
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-1710
Country	:	US
Telephone Number	:	540-855-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	03/24/2017

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