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General NPI Number Information
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NPI Number | 1912457300
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Entity Type | Organization
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Legal Business Name | TRUJILLO VISION AND EYE CARE LLC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 9666 OLDE US 20
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City | ROSSFORD
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State | OH
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Zip | 43460-1710
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Country | US
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Telephone | 419-872-1397
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Fax |
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Provider Business Mailing Address
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Address Line | 5133 BRINTHAVEN DR
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City | SYLVANIA
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State | OH
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Zip | 43560-2842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID TRUJILLO
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Credential | O.D.
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Telephone | 217-621-6053
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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 | 6079
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License Number State | OH
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