Provider Demographics
NPI:1649449034
Name:TROIE, ROGER G (LO)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:G
Last Name:TROIE
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2124
Mailing Address - Country:US
Mailing Address - Phone:860-529-3937
Mailing Address - Fax:860-529-0767
Practice Address - Street 1:415 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2124
Practice Address - Country:US
Practice Address - Phone:860-529-3937
Practice Address - Fax:860-529-0767
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT660156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0633650001Medicare NSC