Provider Demographics
NPI:1710189477
Name:TROAST, BRUCE A (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:A
Last Name:TROAST
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2740
Mailing Address - Country:US
Mailing Address - Phone:973-743-6590
Mailing Address - Fax:973-743-6591
Practice Address - Street 1:476 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2740
Practice Address - Country:US
Practice Address - Phone:973-743-6590
Practice Address - Fax:973-743-6591
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1273156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0666620001Medicare NSC