Provider Demographics
NPI:1790766434
Name:DR PHYLLIS STRICKLAND & ASSOCIATES
Entity Type:Organization
Organization Name:DR PHYLLIS STRICKLAND & ASSOCIATES
Other - Org Name:STRICKLAND EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:MAUDE
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-931-3050
Mailing Address - Street 1:8200 PERRY HALL BLVD
Mailing Address - Street 2:SUITE 2158, LENSCRAFTERS
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4901
Mailing Address - Country:US
Mailing Address - Phone:410-931-3050
Mailing Address - Fax:410-931-8986
Practice Address - Street 1:8200 PERRY HALL BLVD
Practice Address - Street 2:SUITE 2158, LENSCRAFTERS
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4901
Practice Address - Country:US
Practice Address - Phone:410-931-3050
Practice Address - Fax:410-931-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA1242OtherSTATE LICENSE #
MDU61410Medicare UPIN
MDST800454Medicare PIN