=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871529214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL S MCENEANEY O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 08/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 E LAKE ST SUITE 107
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60601-5959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-236-3822
-----------------------------------------------------
Fax | 312-236-3825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 N CARPENTER ST UNIT 4S
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-2199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-988-0093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 46-7708
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------