MEDICARE: CHARLES M. CUMMINS, OD., PA

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

Other Identifiers

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

General Provider Information

NPI Number	:	1598797722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES M. CUMMINS, OD., PA

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	SUITE 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1370
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	1255 BROAD ST
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3000
Country	:	US
Telephone Number	:	973-338-7575
Fax Number	:	973-338-5158

Authorized Official
Title or Position	:	MANAGER OF NETWORK MANAGEMENT
Name	:	DOLSIE MCDONALD
Credential	:
Telephone Number	:	726-444-4078

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/01/2024

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