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General NPI Number Information
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NPI Number | 1114129368
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Entity Type | Organization
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Legal Business Name | CHEATHAM EYECARE LLC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 227 COMMERCE ST
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City | WEST POINT
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State | MS
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Zip | 39773-2921
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Country | US
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Telephone | 662-494-5984
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Fax | 662-494-3805
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Provider Business Mailing Address
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Address Line | 227 COMMERCE ST
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City | WEST POINT
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State | MS
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Zip | 39773-2921
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Country | US
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Telephone | 662-494-5984
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Fax | 662-494-3805
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DAVID W CHEATHAM
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Credential | O.D.
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Telephone | 662-494-5984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | MS656
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License Number State | MS
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