Provider Demographics
NPI:1154633113
Name:TROYER, JEREMIAH JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:JOHN
Last Name:TROYER
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 1:213 GATEWAY BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1174
Mailing Address - Country:US
Mailing Address - Phone:304-645-7797
Mailing Address - Fax:
Practice Address - Street 1:213 GATEWAY BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1174
Practice Address - Country:US
Practice Address - Phone:304-645-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1081-OD152W00000X
VA0618001952152W00000X
MIL1832595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4303101OtherMEDICARE PTAN
WV3810018087Medicaid