Provider Demographics
NPI:1750374617
Name:HOWARD, CHERI DENISE (OD)
Entity type:Individual
Prefix:DR
First Name:CHERI
Middle Name:DENISE
Last Name:HOWARD
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 1:322 S WOODSCREST DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5314
Mailing Address - Country:US
Mailing Address - Phone:812-332-2020
Mailing Address - Fax:812-334-1414
Practice Address - Street 1:322 S WOODSCREST DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5314
Practice Address - Country:US
Practice Address - Phone:812-332-2020
Practice Address - Fax:812-334-1414
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ2304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11479309OtherCAQH
IN545500Medicare PIN
IN11479309OtherCAQH
IN0347310001Medicare NSC