Provider Demographics
NPI:1497827455
Name:TROUTMAN, MARK LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:TROUTMAN
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:P.O. BOX 150
Mailing Address - Street 2:207 W MAIN ST
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437
Mailing Address - Country:US
Mailing Address - Phone:270-389-1864
Mailing Address - Fax:270-389-1616
Practice Address - Street 1:207 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437
Practice Address - Country:US
Practice Address - Phone:270-389-1864
Practice Address - Fax:270-389-1616
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY823152W00000X
KYMARK823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0077311001Medicare NSC
KY9030801Medicare PIN