Provider Demographics
NPI:1336215870
Name:TROESE, VICKI ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ROSE
Last Name:TROESE
Suffix:
Gender:F
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 5377
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-0377
Mailing Address - Country:US
Mailing Address - Phone:856-693-0712
Mailing Address - Fax:
Practice Address - Street 1:1925 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3435
Practice Address - Country:US
Practice Address - Phone:215-568-0660
Practice Address - Fax:215-568-0661
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2466152W00000X
CAOPT 9110152W00000X
PAOEG002191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
585265Medicare PIN
NJU12605Medicare UPIN