Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 277 | AZ |
NPI | 1164636858 |
---|---|
Provider Name | Mr. Sherwin Mark Stradling |
First Address | Avondale, AZ 85323-5892 |
Second Address | Phoenix, AZ 85015-2445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |