Provider Demographics
NPI:1114608064
Name:JUENEMANN, TROY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:MICHAEL
Last Name:JUENEMANN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1635
Mailing Address - Country:US
Mailing Address - Phone:785-470-7576
Mailing Address - Fax:
Practice Address - Street 1:631 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1635
Practice Address - Country:US
Practice Address - Phone:785-845-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist