Provider Demographics
NPI:1922184852
Name:TROMBLEY, STEVEN J
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:TROMBLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E CEDAR AVE
Mailing Address - Street 2:PO276
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-2261
Mailing Address - Country:US
Mailing Address - Phone:989-426-8272
Mailing Address - Fax:989-426-3701
Practice Address - Street 1:202 E CEDAR AVE
Practice Address - Street 2:PO276
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-2261
Practice Address - Country:US
Practice Address - Phone:989-426-8272
Practice Address - Fax:989-426-3701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3212OtherEYEMED ID NUMBER