Provider Demographics
NPI:1275941247
Name:JOSEPH T TRUBIROHA OD LLC
Entity Type:Organization
Organization Name:JOSEPH T TRUBIROHA OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRUBIROHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-995-3766
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-0602
Mailing Address - Country:US
Mailing Address - Phone:231-775-1141
Mailing Address - Fax:231-876-9398
Practice Address - Street 1:8917 E 34 RD
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-7500
Practice Address - Country:US
Practice Address - Phone:231-775-1141
Practice Address - Fax:231-876-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty