Provider Demographics
NPI:1740563741
Name:DR. RUDOLPH W. TROUP, P.C.
Entity Type:Organization
Organization Name:DR. RUDOLPH W. TROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:TROUP
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:318-686-5227
Mailing Address - Street 1:8889 JEWELLA AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2138
Mailing Address - Country:US
Mailing Address - Phone:318-686-5227
Mailing Address - Fax:318-686-5283
Practice Address - Street 1:8889 JEWELLA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2138
Practice Address - Country:US
Practice Address - Phone:318-686-5227
Practice Address - Fax:318-686-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA725178T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19621Medicare UPIN