Provider Demographics
NPI:1447353917
Name:ARCHER, CHERYL (OD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895
Mailing Address - Country:US
Mailing Address - Phone:419-228-3937
Mailing Address - Fax:419-228-3939
Practice Address - Street 1:2765 FORT AMANDA RD
Practice Address - Street 2:SUITE100
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-4813
Practice Address - Country:US
Practice Address - Phone:419-228-3937
Practice Address - Fax:419-228-3939
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3762 T631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128550OtherANTHEM BCBS
OH0800673Medicaid
OH410042664Medicare PIN
OHT48291Medicare UPIN
OH0800673Medicaid
OH4267191Medicare PIN
OH000000128550OtherANTHEM BCBS