Provider Demographics
NPI:1457319113
Name:LANDRY, CHERYL ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:LANDRY
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 1:377 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2300
Mailing Address - Country:US
Mailing Address - Phone:413-584-4040
Mailing Address - Fax:508-793-7856
Practice Address - Street 1:130 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-5130
Practice Address - Country:US
Practice Address - Phone:978-671-9000
Practice Address - Fax:978-671-9095
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00508152W00000X
MA3202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303546Medicaid
RI419002958Medicare PIN
T59427Medicare UPIN