Provider Demographics
NPI:1376605303
Name:TRAPENI, PAUL DOUGLAS JR (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:TRAPENI
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:23 N LOWRY ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-2525
Mailing Address - Country:US
Mailing Address - Phone:615-459-0675
Mailing Address - Fax:615-459-6401
Practice Address - Street 1:23 N LOWRY ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2525
Practice Address - Country:US
Practice Address - Phone:615-459-0675
Practice Address - Fax:615-459-6401
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN941-ODT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6840510001Medicare NSC
TNT61263Medicare UPIN
TN35956621Medicare PIN