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NPI Code Detail

MEDICARE: DR. JODI TRAUB O.D.

MEDICARE:  DR. JODI  TRAUB  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristT-500SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629037189
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JODI TRAUB O.D.
Provider Business Mailing Address
First Line : 5716 W CLAY ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57106-0297
Country : US
Telephone Number : 605-367-3962
Fax Number :
Provider Business Practice Location Address
First Line : 3401 S KELLEY AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57106-6300
Country : US
Telephone Number : 605-361-1680
Fax Number : 605-361-1590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 07/08/2007

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Directions to “ DR. JODI TRAUB O.D.” Practice Location

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