Provider Demographics
NPI:1427052125
Name:LODL, CHERIE S (OD)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:S
Last Name:LODL
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 1:2510 S 171ST CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2394
Mailing Address - Country:US
Mailing Address - Phone:402-330-3063
Mailing Address - Fax:402-334-4418
Practice Address - Street 1:2510 S 171ST CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2394
Practice Address - Country:US
Practice Address - Phone:402-330-3063
Practice Address - Fax:402-334-4418
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE15477OtherSPECTERA
NE36713OtherBLUE CROSS BLUE SHIELD
NE2200244OtherUNITED HEALTHCARE
NE470833584OtherTAX IDENTIFICATION NUMBER
NE86956OtherCOVENTRY
NENE1042OtherMUTUALLY PREFERRED
NEO10900916OtherEXCLUSIVECARE
NE4930110001Medicare NSC
NE266275Medicare PIN
NE2200244OtherUNITED HEALTHCARE