Provider Demographics
NPI:1255482386
Name:STRACH, CHERYL LYNN (OD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:STRACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13497 FALLING STAR DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6280
Mailing Address - Country:US
Mailing Address - Phone:951-674-7433
Mailing Address - Fax:
Practice Address - Street 1:24155 LAGUNA HILLS MALL
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3667
Practice Address - Country:US
Practice Address - Phone:949-458-0119
Practice Address - Fax:949-458-1613
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10735TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU63028Medicare UPIN
CAN-SDO107350Medicare ID - Type Unspecified