MEDICARE: DR. CHERYL S MCENEANEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	46-7708	IL

General Provider Information

NPI Number	:	1871529214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL S MCENEANEY O.D.

Provider Business Mailing Address
First Line	:	16 N CARPENTER ST
Second Line	:	UNIT 4S
City	:	CHICAGO
State	:	IL
Zip	:	60607-2199
Country	:	US
Telephone Number	:	312-988-0093
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 E LAKE ST
Second Line	:	SUITE 107
City	:	CHICAGO
State	:	IL
Zip	:	60601-5959
Country	:	US
Telephone Number	:	312-236-3822
Fax Number	:	312-236-3825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/27/2017

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