MEDICARE: DR. TREVOR NEIL TROGNER OD

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	2248DT	KY

General Provider Information

NPI Number	:	1437729670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR NEIL TROGNER OD

Provider Business Mailing Address
First Line	:	712 PARK LN
Second Line	:
City	:	RADCLIFF
State	:	KY
Zip	:	40160-2329
Country	:	US
Telephone Number	:	540-535-9119
Fax Number	:

Provider Business Practice Location Address
First Line	:	10337 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-3951
Country	:	US
Telephone Number	:	502-916-7400
Fax Number	:

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	06/29/2021

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