Provider Demographics
NPI:1437293602
Name:LAMM, CHERYL ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANNE
Last Name:LAMM
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 1:2018 WOLVERINE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-1757
Mailing Address - Country:US
Mailing Address - Phone:812-760-0752
Mailing Address - Fax:
Practice Address - Street 1:1100 S GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-6804
Practice Address - Country:US
Practice Address - Phone:812-476-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002554152W00000X
IN18002554B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU43416Medicare UPIN
IN546640Medicare ID - Type Unspecified