Provider Demographics
NPI:1881654564
Name:TRUMP, BRUCE L (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
Last Name:TRUMP
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:260-569-0760
Practice Address - Street 1:833 N CASS ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992
Practice Address - Country:US
Practice Address - Phone:260-563-3672
Practice Address - Fax:260-563-6534
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002374A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100195980Medicaid
IN084200AMedicare PIN
IN410035887Medicare PIN
T84747Medicare UPIN
IN861620BMedicare PIN
IN100195980Medicaid