Provider Demographics
NPI:1376529735
Name:STRADEL, JOSEPH WARD (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WARD
Last Name:STRADEL
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 1:919 W KENNEDY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-2205
Mailing Address - Country:US
Mailing Address - Phone:920-733-0919
Mailing Address - Fax:920-733-0912
Practice Address - Street 1:919 W KENNEDY AVE STE A
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2205
Practice Address - Country:US
Practice Address - Phone:920-733-0919
Practice Address - Fax:920-733-0912
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2693 035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38601300Medicaid
WI38601300Medicaid
WI47500 0002Medicare ID - Type Unspecified
WI0296330001Medicare NSC