Provider Demographics
NPI:1972604312
Name:TRUMBORE, TED NEIL (OD)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:NEIL
Last Name:TRUMBORE
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 1:70 BUCKWALTER RD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1846
Mailing Address - Country:US
Mailing Address - Phone:610-948-8900
Mailing Address - Fax:610-948-8380
Practice Address - Street 1:70 BUCKWALTER RD
Practice Address - Street 2:SUITE 506
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1846
Practice Address - Country:US
Practice Address - Phone:610-948-8900
Practice Address - Fax:610-948-8380
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07250Medicare ID - Type Unspecified
PAU34029Medicare UPIN