Provider Demographics
NPI:1356361570
Name:ADAMS, CHERYL LYNNE (OD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNNE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNNE
Other - Last Name:GOODING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6725 MIAMI AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-3158
Mailing Address - Country:US
Mailing Address - Phone:513-561-7076
Mailing Address - Fax:
Practice Address - Street 1:6725 MIAMI AVE STE 101
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-3158
Practice Address - Country:US
Practice Address - Phone:513-561-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6083152W00000X
IL046009883152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009883Medicaid
ILK28829Medicare PIN
V09617Medicare UPIN