=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689605032
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. NORBERT JOSEPH TRAUTNER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 347 2ND STREET PIKE
-----------------------------------------------------
City | SOUTHAMPTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18966-3831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-322-7230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3989 BUCK RD
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-947-1145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------