Healthcare Provider Details

I. General information

NPI: 1376529735
Provider Name (Legal Business Name): JOSEPH WARD STRADEL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 W KENNEDY AVE STE A
KIMBERLY WI
54136-2205
US

IV. Provider business mailing address

919 W KENNEDY AVE STE A
KIMBERLY WI
54136-2205
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-0919
  • Fax: 920-733-0912
Mailing address:
  • Phone: 920-733-0919
  • Fax: 920-733-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2693 035
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: