Provider Demographics
NPI:1598740276
Name:STROUD, JAMES B (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:STROUD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18431 N 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0817
Mailing Address - Country:US
Mailing Address - Phone:623-933-6586
Mailing Address - Fax:623-933-9320
Practice Address - Street 1:18431 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-0817
Practice Address - Country:US
Practice Address - Phone:623-933-6586
Practice Address - Fax:623-933-9320
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1395OtherSTATE LISCENSE
AZZ106340Medicare PIN
AZ1395OtherSTATE LISCENSE