Provider Demographics
NPI:1821079005
Name:TROUTMAN, TIMOTHY HARRELD JR (OD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:HARRELD
Last Name:TROUTMAN
Suffix:JR
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:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-0360
Mailing Address - Country:US
Mailing Address - Phone:812-683-4443
Mailing Address - Fax:812-683-5409
Practice Address - Street 1:303 13TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9269
Practice Address - Country:US
Practice Address - Phone:812-683-4443
Practice Address - Fax:812-683-5409
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16460T152W00000X
IN18003367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200523320Medicaid
IN213550DOtherMEDICARE ID
IN200523320Medicaid