Individual
DR. CHERYL COLLEEN VAN HORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
717 FAIRMONT AVE, FAIRMONT, WV 26554-5135
(304) 366-3830
(304) 366-8049
Mailing address
717 FAIRMONT AVE, FAIRMONT, WV 26554-5135
(304) 366-3830
(304) 366-8049
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
853-OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001719073
BLUE CROSS NUMBER
WV
05
—
0149347000
—
WV
01
—
0867551
UMWA FUNDS
WV
01
—
9927631
MEDICARE PTAN
WV
Enumeration date
10/26/2006
Last updated
08/14/2014
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