Provider Demographics
NPI:1982753646
Name:TRAPP, KEVIN JON (OD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JON
Last Name:TRAPP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:JON
Other - Last Name:TRAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1332
Mailing Address - Country:US
Mailing Address - Phone:248-352-2806
Mailing Address - Fax:248-352-9590
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1332
Practice Address - Country:US
Practice Address - Phone:248-352-2806
Practice Address - Fax:248-352-9590
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004206152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU99313Medicare UPIN
MION52450Medicare PIN