Provider Demographics
NPI:1902809296
Name:POWERS, TROY M (OD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:M
Last Name:POWERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1600 MILLER TRUNK HWY
Mailing Address - Street 2:STE 429
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5643
Mailing Address - Country:US
Mailing Address - Phone:218-727-5457
Mailing Address - Fax:218-740-3094
Practice Address - Street 1:1600 MILLER TRUNK HWY
Practice Address - Street 2:STE 429
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5643
Practice Address - Country:US
Practice Address - Phone:218-727-5457
Practice Address - Fax:218-740-3094
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2376152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-00369OtherMEDICA
MN4C257POOtherBCBS
MN22-00369OtherMEDICA