Provider Demographics
NPI:1033155841
Name:TROUTMAN, THOMAS M (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:TROUTMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:951 VIEWPOINT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4915
Mailing Address - Country:US
Mailing Address - Phone:630-444-0419
Mailing Address - Fax:
Practice Address - Street 1:2000 SPRING HILL MALL
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1270
Practice Address - Country:US
Practice Address - Phone:847-428-9830
Practice Address - Fax:847-428-5626
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532290OtherBCBS
IL04532290OtherBCBS
ILV07339Medicare UPIN