Provider Demographics
NPI:1003978941
Name:SCHAUM, TRACI A (OD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:A
Last Name:SCHAUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:A
Other - Last Name:ROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6614 LOGAN DR
Mailing Address - Street 2:EVANSVILLE
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8236
Mailing Address - Country:US
Mailing Address - Phone:812-477-6700
Mailing Address - Fax:812-477-2152
Practice Address - Street 1:6614 LOGAN DR
Practice Address - Street 2:EVANSVILLE
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8236
Practice Address - Country:US
Practice Address - Phone:812-477-6700
Practice Address - Fax:812-477-2152
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002245B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN636550Medicare UPIN