Provider Demographics
NPI:1164579918
Name:EVERITT, CHERYL MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:MARIE
Last Name:EVERITT
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 1:7379 INDIANA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4547
Mailing Address - Country:US
Mailing Address - Phone:951-684-7822
Mailing Address - Fax:951-977-8075
Practice Address - Street 1:7379 INDIANA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4547
Practice Address - Country:US
Practice Address - Phone:951-684-7822
Practice Address - Fax:951-977-8075
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10316T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD249AOtherMEDICARE GROUP PTAN
CASD0103160Medicaid
CACS117ZMedicare PIN
CASD0103160Medicaid
CAP00094927Medicare PIN
CASD0103161Medicare PIN
CAP00094927Medicare PIN