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General NPI Number Information
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NPI Number | 1790762144
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Entity Type | Individual
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Provider Name | CHERIE A. OSHIRO-JOHNSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 3105 FIELDS SOUTH DR. OPTHALMOLOGY/OPTOMETRY
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City | CHAMPAIGN
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State | IL
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Zip | 61822
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Country | US
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Telephone | 217-383-3150
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Fax | 217-383-4845
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Provider Business Mailing Address
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Address Line | 611 W. PARK ST. FAPC
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City | URBANA
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State | IL
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Zip | 61801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.009109
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License Number State | IL
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