Provider Demographics
NPI:1841899473
Name:CHERIAN, JOANN THOMAS (OD)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:THOMAS
Last Name:CHERIAN
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 1:1200 NW 178TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4463
Mailing Address - Country:US
Mailing Address - Phone:405-509-2100
Mailing Address - Fax:
Practice Address - Street 1:1200 NW 178TH ST STE 100
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-4463
Practice Address - Country:US
Practice Address - Phone:405-509-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9989152W00000X
OK3102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty