Provider Demographics
NPI:1689750507
Name:TRUBIROHA, JOSEPH T (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:TRUBIROHA
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 1:8917 E 34 RD
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8851
Mailing Address - Country:US
Mailing Address - Phone:231-775-1141
Mailing Address - Fax:
Practice Address - Street 1:8917 E 34 RD
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8851
Practice Address - Country:US
Practice Address - Phone:231-775-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist