Provider Demographics
NPI:1922041458
Name:STROUD, SANDRA (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:STROUD
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 1:41272 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-5106
Mailing Address - Country:US
Mailing Address - Phone:727-937-6551
Mailing Address - Fax:727-942-7200
Practice Address - Street 1:41272 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-5106
Practice Address - Country:US
Practice Address - Phone:727-937-6551
Practice Address - Fax:727-942-7200
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620286101Medicaid
FL620286100Medicaid
FL620286100Medicaid
FLU57429Medicare UPIN
FL20597BMedicare ID - Type Unspecified
FLFR277AMedicare PIN