Provider Demographics
NPI:1992057236
Name:STUCHL, SARAH JEANNE (OD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JEANNE
Last Name:STUCHL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-0229
Mailing Address - Country:US
Mailing Address - Phone:701-523-7707
Mailing Address - Fax:
Practice Address - Street 1:16 W DIVIDE
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623
Practice Address - Country:US
Practice Address - Phone:701-523-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD720152W00000X
NDND739152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program