Provider Demographics
NPI:1053514927
Name:CHEEKS OPTICAL INC
Entity type:Organization
Organization Name:CHEEKS OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:CHEEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPO
Authorized Official - Phone:931-388-2061
Mailing Address - Street 1:1922 SHADY BROOK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3989
Mailing Address - Country:US
Mailing Address - Phone:931-388-9973
Mailing Address - Fax:
Practice Address - Street 1:1922 SHADY BROOK ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3989
Practice Address - Country:US
Practice Address - Phone:931-388-9973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO487332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0684210001Medicare NSC