Provider Demographics
NPI:1245290923
Name:TRUMP, NATHAN D (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:D
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 1:1201 STATE ROAD 114 E
Mailing Address - Street 2:
Mailing Address - City:NORTH MANCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46962-9393
Mailing Address - Country:US
Mailing Address - Phone:260-982-8681
Mailing Address - Fax:260-982-2912
Practice Address - Street 1:1201 STATE ROAD 114 E
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962
Practice Address - Country:US
Practice Address - Phone:260-982-8681
Practice Address - Fax:260-982-2912
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
IN18003366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200522090Medicaid
INP00366321Medicare PIN
INP00658001Medicare PIN
IN252690EMedicare PIN
INV05622Medicare UPIN
IN200522090Medicaid
IN267880BMedicare PIN
IN861620GMedicare PIN
INP00616238Medicare PIN
IN140690CMedicare PIN
IN160450OMedicare PIN
IN425270JMedicare PIN
INP00251908Medicare PIN