Provider Demographics
NPI:1609954866
Name:TROUPE, TIMOTHY JOHN (OD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:TROUPE
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 1:13385 PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9249
Mailing Address - Country:US
Mailing Address - Phone:269-655-4014
Mailing Address - Fax:
Practice Address - Street 1:882 M 72 NW
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-8787
Practice Address - Country:US
Practice Address - Phone:231-258-9781
Practice Address - Fax:231-258-0616
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003903152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901003903OtherSTATE LICENSE
MIM39690004OtherMEDICARE PTAN