Provider Demographics
NPI:1457558405
Name:DR. J . C. TROTTER, INC. P.C.
Entity Type:Organization
Organization Name:DR. J . C. TROTTER, INC. P.C.
Other - Org Name:DR. J. C. TROTTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:C
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-765-3379
Mailing Address - Street 1:521 E HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2004
Mailing Address - Country:US
Mailing Address - Phone:580-765-3379
Mailing Address - Fax:
Practice Address - Street 1:521 E HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2004
Practice Address - Country:US
Practice Address - Phone:580-765-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0436620001Medicare ID - Type UnspecifiedPALMETTO DME GROUP #