Provider Demographics
NPI:1417700824
Name:TROY J. LEBARON OD PLLC
Entity Type:Organization
Organization Name:TROY J. LEBARON OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBARON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-469-0056
Mailing Address - Street 1:6075 ADA DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7547
Mailing Address - Country:US
Mailing Address - Phone:616-469-0056
Mailing Address - Fax:
Practice Address - Street 1:4326 28TH ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-1908
Practice Address - Country:US
Practice Address - Phone:616-949-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty