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General NPI Number Information
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NPI Number | 1679673495
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Entity Type | Organization
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Legal Business Name | MARTINSVILLE VISION CLINIC PC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 219 E WASHINGTON ST
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1554
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Country | US
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Telephone | 765-342-6654
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Fax | 765-342-0418
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Provider Business Mailing Address
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Address Line | 219 E WASHINGTON ST
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1554
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Country | US
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Telephone | 765-342-6654
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Fax | 765-342-0418
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. AARON B CUNNINGHAM
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Credential | OD
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Telephone | 765-342-6654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18001572B
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003161B
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002989B
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License Number State | IN
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