Provider Demographics
NPI:1164636858
Name:STRADLING, SHERWIN MARK (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:SHERWIN
Middle Name:MARK
Last Name:STRADLING
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 N 110TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5892
Mailing Address - Country:US
Mailing Address - Phone:602-242-3486
Mailing Address - Fax:
Practice Address - Street 1:2040 W BETHANY HOME RD
Practice Address - Street 2:SUITE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2445
Practice Address - Country:US
Practice Address - Phone:602-242-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ277156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician