Provider Demographics
NPI:1457647125
Name:CHEEK, AMANDA RENEE (OD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:CHEEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RENEE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4344 MORMON COULEE RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7908
Mailing Address - Country:US
Mailing Address - Phone:608-788-8800
Mailing Address - Fax:608-788-5790
Practice Address - Street 1:4344 MORMON COULEE RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7908
Practice Address - Country:US
Practice Address - Phone:608-788-8800
Practice Address - Fax:608-788-5790
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3219-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist