MEDICARE: DR. ROBERT KUMMER O.D.

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	5550T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00361101	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568469732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT KUMMER O.D.

Provider Business Mailing Address
First Line	:	1421 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3401
Country	:	US
Telephone Number	:	310-274-0653
Fax Number	:	310-274-0360

Provider Business Practice Location Address
First Line	:	1421 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3401
Country	:	US
Telephone Number	:	310-274-0653
Fax Number	:	310-274-0360

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

Provider Enumeration Date	:	07/04/2005
Last Update Date	:	02/07/2008

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