Healthcare Provider Details

I. General information

NPI: 1730257809
Provider Name (Legal Business Name): REX ALLEN CUMMINGS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ROYAL ST
RAVENSWOOD WV
26164-1725
US

IV. Provider business mailing address

105 ROYAL ST
RAVENSWOOD WV
26164-1725
US

V. Phone/Fax

Practice location:
  • Phone: 304-273-5333
  • Fax: 304-273-5334
Mailing address:
  • Phone: 304-273-5333
  • Fax: 304-273-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0679D
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: