Healthcare Provider Details

I. General information

NPI: 1427052125
Provider Name (Legal Business Name): CHERIE S LODL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 S 171ST CT
OMAHA NE
68130-2394
US

IV. Provider business mailing address

2510 S 171ST CT
OMAHA NE
68130-2394
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-3063
  • Fax: 402-334-4418
Mailing address:
  • Phone: 402-330-3063
  • Fax: 402-334-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1042
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: