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General NPI Number Information
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NPI Number | 1275941247
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Entity Type | Organization
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Legal Business Name | JOSEPH T TRUBIROHA OD LLC
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 8917 E 34 RD
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City | CADILLAC
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State | MI
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Zip | 49601-7500
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Country | US
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Telephone | 231-775-1141
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Fax | 231-876-9398
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Provider Business Mailing Address
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Address Line | PO BOX 602
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City | TRAVERSE CITY
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State | MI
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Zip | 49685-0602
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Country | US
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Telephone | 231-775-1141
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Fax | 231-876-9398
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JOSEPH T TRUBIROHA
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Credential | OD
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Telephone | 231-995-3766
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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 | 4901002832
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License Number State | MI
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