Healthcare Provider Details

I. General information

NPI: 1376507376
Provider Name (Legal Business Name): JOHN CUNNINGHAM TOWNSEND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S GAY ST ROOM 714
BALTIMORE MD
21202-7500
US

IV. Provider business mailing address

3868 WOODVILLE LN
ELLICOTT CITY MD
21042-4836
US

V. Phone/Fax

Practice location:
  • Phone: 410-779-1576
  • Fax: 410-779-1581
Mailing address:
  • Phone: 410-750-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7372T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1507
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1142
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02407
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2085
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2652T
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2001TX
License Number StateWA
# 8
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number711-OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: