Provider Demographics
NPI:1770546442
Name:CAUTHEN, CHERYL GENESSA (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:GENESSA
Last Name:CAUTHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NORFOLK EYE PHYSICIA
Other - Middle Name:
Other - Last Name:AND SURGEONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1005 MAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3423
Mailing Address - Country:US
Mailing Address - Phone:757-623-2123
Mailing Address - Fax:757-622-8806
Practice Address - Street 1:1005 MAY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3423
Practice Address - Country:US
Practice Address - Phone:757-623-2123
Practice Address - Fax:757-622-8806
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034703207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006378838Medicaid
1720146087OtherNORFOLK EYE PHYSICIANS AND SURGEONS
VAC00740Medicare PIN
VAB07982Medicare UPIN
1720146087OtherNORFOLK EYE PHYSICIANS AND SURGEONS