Healthcare Provider Details

I. General information

NPI: 1063630887
Provider Name (Legal Business Name): PETER M KUMPITCH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ISLAND MEDICAL CENTER SUNNY ISLE 4500 SION FERM
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

PO BOX 5996
CHRISTIANSTED VI
00823-5996
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-4686
  • Fax: 340-778-0977
Mailing address:
  • Phone: 340-778-4686
  • Fax: 340-778-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number#6
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: