Provider Demographics
NPI:1881605962
Name:TRUMP, MICHELLE RENEE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENEE
Last Name:TRUMP
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 1:750 MAPLE ST
Mailing Address - Street 2:DR. MICHELLE R. TRUMP, PC
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2908
Mailing Address - Country:US
Mailing Address - Phone:603-630-3686
Mailing Address - Fax:570-329-0190
Practice Address - Street 1:1015 NORTH LOYALSOCK AVE.
Practice Address - Street 2:VISION CENTER C/O DR. MICHELLE TRUMP
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2283
Practice Address - Country:US
Practice Address - Phone:570-368-8820
Practice Address - Fax:570-329-0190
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH789152W00000X
PAOB009154152W00000X
VA0618000608152W00000X
PAOEG001436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU72748Medicare UPIN