Provider Demographics
NPI:1225030109
Name:SULKES, CHAD TREVOR (OD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:TREVOR
Last Name:SULKES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 BIG SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8327
Mailing Address - Country:US
Mailing Address - Phone:239-417-0467
Mailing Address - Fax:239-417-2291
Practice Address - Street 1:157 BIG SPRINGS DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8327
Practice Address - Country:US
Practice Address - Phone:239-417-0467
Practice Address - Fax:239-417-2291
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620912200Medicaid
FL450292Medicare ID - Type Unspecified
V00229Medicare UPIN