Healthcare Provider Details

I. General information

NPI: 1790766434
Provider Name (Legal Business Name): DR PHYLLIS STRICKLAND & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 PERRY HALL BLVD SUITE 2158, LENSCRAFTERS
NOTTINGHAM MD
21236-4901
US

IV. Provider business mailing address

8200 PERRY HALL BLVD SUITE 2158, LENSCRAFTERS
NOTTINGHAM MD
21236-4901
US

V. Phone/Fax

Practice location:
  • Phone: 410-931-3050
  • Fax: 410-931-8986
Mailing address:
  • Phone: 410-931-3050
  • Fax: 410-931-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1242
License Number StateMD

VIII. Authorized Official

Name: DR. PHYLLIS MAUDE STRICKLAND
Title or Position: OWNER
Credential: O.D.
Phone: 410-931-3050