Provider Demographics
NPI:1093808776
Name:SANDRA STROUD OD PA
Entity Type:Organization
Organization Name:SANDRA STROUD OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-937-6551
Mailing Address - Street 1:8864 STATE ROAD 52
Mailing Address - Street 2:PLAZA OF THE OAKS
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6741
Mailing Address - Country:US
Mailing Address - Phone:727-819-0990
Mailing Address - Fax:
Practice Address - Street 1:8864 STATE ROAD 52
Practice Address - Street 2:PLAZA OF THE OAKS
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6741
Practice Address - Country:US
Practice Address - Phone:727-819-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0002767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU57429Medicare UPIN
FL20597EMedicare ID - Type Unspecified