Provider Demographics
NPI:1134386485
Name:DR. R A CHERRY INC
Entity type:Organization
Organization Name:DR. R A CHERRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-693-4488
Mailing Address - Street 1:3017 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3307
Mailing Address - Country:US
Mailing Address - Phone:419-693-4488
Mailing Address - Fax:419-693-9615
Practice Address - Street 1:3017 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3307
Practice Address - Country:US
Practice Address - Phone:419-693-4488
Practice Address - Fax:419-693-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0668504Medicaid
OH0419520001Medicare NSC
OH0668504Medicaid