MEDICARE: DR. RYAN MICHAEL TRIMBLE 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	002674	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	D400006963	OTHER	CT	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	38387	OTHER	CT	CT CONTROLLED SUBSTANCE

General Provider Information

NPI Number	:	1932185303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MICHAEL TRIMBLE O.D.

Provider Business Mailing Address
First Line	:	9 SCHOOL ST # B1
Second Line	:
City	:	UNIONVILLE
State	:	CT
Zip	:	06085-1018
Country	:	US
Telephone Number	:	860-255-7691
Fax Number	:	860-321-7380

Provider Business Practice Location Address
First Line	:	9 SCHOOL ST # B1
Second Line	:
City	:	UNIONVILLE
State	:	CT
Zip	:	06085-1018
Country	:	US
Telephone Number	:	860-255-7691
Fax Number	:	860-321-7380

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	03/07/2023

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