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General NPI Number Information
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NPI Number | 1952716987
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Entity Type | Organization
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Legal Business Name | CHERRY OPTICAL INC.
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Dates
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Enumeration Date | 06/28/2014
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Last Update Date | 06/28/2014
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Provider Practice Location Address
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Address Line | 1640B FIRE LANE DR
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City | GREEN BAY
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State | WI
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Zip | 54311-6245
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Country | US
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Telephone | 920-469-2559
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Fax | 920-469-2658
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Provider Business Mailing Address
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Address Line | 1640B FIRE LANE DR
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City | GREEN BAY
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State | WI
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Zip | 54311-6245
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Country | US
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Telephone | 920-469-2559
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Fax | 920-469-2658
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Authorized Official
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Title or Position | OWNER/VICE PRESIDENT
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Name | JOSEPH ARON CHERRY
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Credential |
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Telephone | 920-469-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 456-0000179711-03
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License Number State | WI
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