Provider Demographics
NPI:1932185303
Name:TRIMBLE, RYAN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:TRIMBLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SCHOOL ST # B1
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1018
Mailing Address - Country:US
Mailing Address - Phone:860-255-7691
Mailing Address - Fax:860-321-7380
Practice Address - Street 1:9 SCHOOL ST # B1
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1018
Practice Address - Country:US
Practice Address - Phone:860-255-7691
Practice Address - Fax:860-321-7380
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004251899Medicaid
CTD400006963OtherMEDICARE ID
CT38387OtherCT CONTROLLED SUBSTANCE
CT38387OtherCT CONTROLLED SUBSTANCE
CT004251899Medicaid