Provider Demographics
NPI:1023019502
Name:TRAUSTASON, OLI I (MD)
Entity Type:Individual
Prefix:DR
First Name:OLI
Middle Name:I
Last Name:TRAUSTASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 SW UMATILLA AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7197
Mailing Address - Country:US
Mailing Address - Phone:541-548-7170
Mailing Address - Fax:541-548-3842
Practice Address - Street 1:1775 SW UMATILLA AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7197
Practice Address - Country:US
Practice Address - Phone:541-548-7170
Practice Address - Fax:541-548-3842
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09829207W00000X
WAMD00026268207W00000X
IDM-6100207W00000X
CAG33242207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10283OtherCLEAR CHOICE
ORA009OtherTRIWEST CHAMPUS
OR001193Medicaid
OR200225OtherCOIHS
OR053857009OtherREGENCE BCBS
OR180029258OtherRAILROAD MEDICARE
OR001193Medicaid