Provider Demographics
NPI:1952716987
Name:CHERRY OPTICAL INC.
Entity Type:Organization
Organization Name:CHERRY OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ARON
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-469-2559
Mailing Address - Street 1:1640B FIRE LANE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6245
Mailing Address - Country:US
Mailing Address - Phone:920-469-2559
Mailing Address - Fax:920-469-2658
Practice Address - Street 1:1640B FIRE LANE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6245
Practice Address - Country:US
Practice Address - Phone:920-469-2559
Practice Address - Fax:920-469-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-28
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI456-0000179711-03291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory