Provider Demographics
NPI:1760578454
Name:CHERRY, RICK A (OD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:A
Last Name:CHERRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 SYLVANIA AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3933
Mailing Address - Country:US
Mailing Address - Phone:419-517-7106
Mailing Address - Fax:419-517-7110
Practice Address - Street 1:6600 SYLVANI AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3933
Practice Address - Country:US
Practice Address - Phone:419-517-7106
Practice Address - Fax:419-517-7110
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0668504Medicaid
OH0419520002Medicare NSC
OHCH0600732Medicare PIN