MEDICARE: DR. DANIEL LEE CUNNINGHAM OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	S530TA161	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51059761	OTHER		BCBS

General Provider Information

NPI Number	:	1467466847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL LEE CUNNINGHAM OD

Provider Business Mailing Address
First Line	:	5550 WARES FERRY ROAD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-2113
Country	:	US
Telephone Number	:	334-271-3937
Fax Number	:	334-279-7434

Provider Business Practice Location Address
First Line	:	5550 WARES FERRY RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-2113
Country	:	US
Telephone Number	:	334-271-3937
Fax Number	:	334-279-7434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	04/30/2014

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