Provider Demographics
NPI:1205826138
Name:KREDA, SHELDON H (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:H
Last Name:KREDA
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 1:7020 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2122
Mailing Address - Country:US
Mailing Address - Phone:954-749-0000
Mailing Address - Fax:954-742-3492
Practice Address - Street 1:7020 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2122
Practice Address - Country:US
Practice Address - Phone:954-749-0000
Practice Address - Fax:954-742-3492
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-22
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001423152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084938300Medicaid
FLT54798Medicare UPIN
FL19107Medicare ID - Type Unspecified