Provider Demographics
NPI:1467423210
Name:CHEATHAM, DAVID W (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-2921
Mailing Address - Country:US
Mailing Address - Phone:662-495-5984
Mailing Address - Fax:662-494-3805
Practice Address - Street 1:227 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-2921
Practice Address - Country:US
Practice Address - Phone:662-495-5984
Practice Address - Fax:662-494-3805
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880152Medicaid
MS00880152Medicaid
MS410000278Medicare PIN