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NPI Code Detail

MEDICARE: TROY J. LEBARON OD PLLC

MEDICARE: TROY J. LEBARON OD PLLC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1417700824
Entity Type Code : Organization
Provider Name (Legal Business Name) : TROY J. LEBARON OD PLLC
Provider Business Mailing Address
First Line : 6075 ADA DR SE
Second Line :
City : ADA
State : MI
Zip : 49301-7547
Country : US
Telephone Number : 616-469-0056
Fax Number :
Provider Business Practice Location Address
First Line : 4326 28TH ST SE
Second Line :
City : KENTWOOD
State : MI
Zip : 49512-1908
Country : US
Telephone Number : 616-949-7442
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST/ OWNER
Name : DR. TROY LEBARON
Credential : OD
Telephone Number : 616-469-0056
Provider Enumeration Date : 04/08/2024
Last Update Date : 04/08/2024

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