Provider Demographics
NPI:1740204452
Name:RADANEATA, CHERYL LYNN (OD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:RADANEATA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:CHICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5718 MCARDLE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3488
Mailing Address - Country:US
Mailing Address - Phone:361-888-4288
Mailing Address - Fax:361-888-4786
Practice Address - Street 1:5718 MCARDLE RD
Practice Address - Street 2:STE 104
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3488
Practice Address - Country:US
Practice Address - Phone:361-888-4288
Practice Address - Fax:361-888-4786
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05188TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80145QOtherBLUE CROSS/ BLUE SHIELD
TX410039537OtherMEDICARE-RAILROAD
TX093468901Medicaid
TX093468901Medicaid
83237EMedicare PIN