MEDICARE: MARTINSVILLE VISION CLINIC PC

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	152W00000X	Optometrist	18001572B	IN
2	152W00000X	Optometrist	18003161B	IN
3	152W00000X	Optometrist	18002989B	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1881693547	OTHER	IN	KELLY CUNNINGHAM NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1023017639	OTHER	IN	THEODORE REX LEGLER II NPI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1871592535	OTHER	IN	AARON CUNNINGHAM NPI

General Provider Information

NPI Number	:	1679673495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTINSVILLE VISION CLINIC PC

Provider Business Mailing Address
First Line	:	219 E WASHINGTON ST
Second Line	:
City	:	MARTINSVILLE
State	:	IN
Zip	:	46151-1554
Country	:	US
Telephone Number	:	765-342-6654
Fax Number	:	765-342-0418

Provider Business Practice Location Address
First Line	:	219 E WASHINGTON ST
Second Line	:
City	:	MARTINSVILLE
State	:	IN
Zip	:	46151-1554
Country	:	US
Telephone Number	:	765-342-6654
Fax Number	:	765-342-0418

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. AARON B CUNNINGHAM
Credential	:	OD
Telephone Number	:	765-342-6654

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/02/2008

Similar Medicare Providers

1881693547 — DR. KELLY LYNNE CUNNINGHAM OD
Practice Location Address:

219 E WASHINGTON ST
MARTINSVILLE, IN
46151-1554

Practice Phone: 765-342-6654
Practice Fax: 765-342-0418

1871592535 — DR. AARON BOOTH CUNNINGHAM OD
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46151-1554

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