Provider Demographics
NPI:1386676609
Name:STRAUMAN, GERALD D (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:D
Last Name:STRAUMAN
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 1:300 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-1140
Mailing Address - Country:US
Mailing Address - Phone:309-543-4436
Mailing Address - Fax:309-543-4437
Practice Address - Street 1:300 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1140
Practice Address - Country:US
Practice Address - Phone:309-543-4436
Practice Address - Fax:309-543-4437
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0377540001Medicare NSC
IL222740Medicare ID - Type UnspecifiedMEDICARE PROVIDER
ILT35411Medicare UPIN