Provider Demographics
NPI:1457438335
Name:STRAUB, AMIE REBEKAH (OD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:REBEKAH
Last Name:STRAUB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 GAYNELLE LN
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-1417
Mailing Address - Country:US
Mailing Address - Phone:580-726-2512
Mailing Address - Fax:
Practice Address - Street 1:112 VAL VERDE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1190
Practice Address - Country:US
Practice Address - Phone:580-482-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2505152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKV11782Medicare UPIN