Provider Demographics
NPI:1194158337
Name:STRAUT, ERIC ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROBERT
Last Name:STRAUT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:ROBERT
Other - Last Name:STRAUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:175 E NASA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1998
Mailing Address - Country:US
Mailing Address - Phone:321-805-3700
Mailing Address - Fax:321-392-6508
Practice Address - Street 1:175 E NASA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1998
Practice Address - Country:US
Practice Address - Phone:321-805-3700
Practice Address - Fax:321-392-6508
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC4816OtherOPTOMETRY LICENSE