Healthcare Provider Details

I. General information

NPI: 1427383785
Provider Name (Legal Business Name): CHERYL L DUMONT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3879 N SCHREIBER WAY
COEUR D ALENE ID
83815
US

IV. Provider business mailing address

4484 NW WOODGATE AVE
PORTLAND OR
97229
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-1802
  • Fax: 208-667-1285
Mailing address:
  • Phone: 208-667-1802
  • Fax: 208-667-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number662
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberODP-100046
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: