Healthcare Provider Details

I. General information

NPI: 1063504694
Provider Name (Legal Business Name): CHERYL ANNE LENNARD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 N UNIVERSITY DR
CORAL SPRINGS FL
33065-5010
US

IV. Provider business mailing address

1807 NE 59TH ST
FORT LAUDERDALE FL
33308-2443
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-1551
  • Fax: 954-752-3958
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPC3719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: