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General NPI Number Information
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NPI Number | 1205956596
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Entity Type | Organization
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Legal Business Name | GLADWIN OPTOMETRIC CENTER INC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 202 E CEDAR AVE PO 276
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City | GLADWIN
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State | MI
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Zip | 48624-2261
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Country | US
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Telephone | 989-422-6827
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Fax | 989-426-3701
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Provider Business Mailing Address
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Address Line | 202 E CEDAR AVE PO276
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City | GLADWIN
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State | MI
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Zip | 48624-2261
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Country | US
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Telephone | 989-426-8272
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Fax | 989-426-3701
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. STEVEN J TROMBLEY
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Credential |
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Telephone | 989-426-8272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3212
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License Number State | MI
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