Basic Information
| Provider Information | |||||||||
| NPI: | 1033121884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARKASH | ||||||||
| FirstName: | CHERIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 SOUTH STATE STREET | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 WALL ST | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481051912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347644190 | ||||||||
| FaxNumber: | 7346478052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901004786 | MI | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 4617 | MA | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 00013301 | 01 | MA | MEDICARE | OTHER | MA4617 | 01 | EYEMED | OTHER | 7130958 | 01 | AETNA | OTHER | 0713554 | 01 | MASS HEALTH | OTHER | 8349617 | 01 | CIGNA | OTHER | 9721100 | 01 | MASS HEALTH GROUP NUMBER | OTHER | AA94651 | 01 | HARVARD PILGRIM | OTHER |