Provider Demographics
NPI:1982833059
Name:CHERISCA, ANDRE JR
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:CHERISCA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4065
Mailing Address - Country:US
Mailing Address - Phone:301-498-2003
Mailing Address - Fax:301-725-3271
Practice Address - Street 1:615 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4065
Practice Address - Country:US
Practice Address - Phone:301-498-2003
Practice Address - Fax:301-725-3271
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician