Healthcare Provider Details

I. General information

NPI: 1639297914
Provider Name (Legal Business Name): LLOYD CUNNINGHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 CENTURY BLVD
PITTSBURG CA
94565-7113
US

IV. Provider business mailing address

4241 CENTURY BLVD
PITTSBURG CA
94565
US

V. Phone/Fax

Practice location:
  • Phone: 925-706-4400
  • Fax: 925-706-4411
Mailing address:
  • Phone: 925-706-4400
  • Fax: 925-706-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD6247
License Number StateCA

VIII. Authorized Official

Name: MR. LLOYD ANTHONEY CUNNINGHAM
Title or Position: OWNER
Credential:
Phone: 925-706-4400