Provider Demographics
NPI:1124104229
Name:STRICKLER, TRAVIS B (OD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:B
Last Name:STRICKLER
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 1:3554 PROMENADE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8418
Mailing Address - Country:US
Mailing Address - Phone:765-607-1131
Mailing Address - Fax:765-607-1454
Practice Address - Street 1:3554 PROMENADE PKWY STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909
Practice Address - Country:US
Practice Address - Phone:765-607-1131
Practice Address - Fax:765-607-1454
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003240B152W00000X
IN18003240A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201262990Medicaid
158230001Medicare PIN