Basic Information
| Provider Information | |||||||||
| NPI: | 1265890156 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHARLES M CUMMINS, OD, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VISIONWORKS DOCTORS OF OPTOMETRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846338 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003400129 | ||||||||
| FaxNumber: | 2105246587 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 MOUNT HOPE AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ROCKAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078661661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003400129 | ||||||||
| FaxNumber: | 2105246587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | CUMMINS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9735687680 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.