MEDICARE: TROY M POWERS O.D.

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	2376	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22-00369	OTHER	MN	MEDICA
2	4C257PO	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1902809296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY M POWERS O.D.

Provider Business Mailing Address
First Line	:	1600 MILLER TRUNK HWY
Second Line	:	STE 429
City	:	DULUTH
State	:	MN
Zip	:	55811-5643
Country	:	US
Telephone Number	:	218-727-5457
Fax Number	:	218-740-3094

Provider Business Practice Location Address
First Line	:	1600 MILLER TRUNK HWY
Second Line	:	STE 429
City	:	DULUTH
State	:	MN
Zip	:	55811-5643
Country	:	US
Telephone Number	:	218-727-5457
Fax Number	:	218-740-3094

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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