Provider Demographics
NPI:1972582070
Name:ARCHAMBEAULT, CHERIE RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHERIE
Middle Name:RENEE
Last Name:ARCHAMBEAULT
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 1:630 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4900
Mailing Address - Country:US
Mailing Address - Phone:865-475-4500
Mailing Address - Fax:
Practice Address - Street 1:630 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4900
Practice Address - Country:US
Practice Address - Phone:865-475-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4084688OtherBCBS AND BLUECARE
TNP00135659OtherRAILROAD MEDICARE
TN0420430001OtherDMERC PROVIDER NUMBER
TN3946039Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TNU96982Medicare UPIN