MEDICARE: CHARLES M CUMMINS OD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346207644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES M CUMMINS OD PA

Provider Business Mailing Address
First Line	:	PO BOX 846338
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6338
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	1900 ROUTE 70
Second Line	:	SUITE 216
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-7324
Country	:	US
Telephone Number	:	732-864-0755
Fax Number	:	732-458-1908

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES M. CUMMINS
Credential	:	O.D.
Telephone Number	:	973-338-8886

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	08/09/2013

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