MEDICARE: DR. ROSEMARIE R. CUNNINGHAM 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	OA03028	NJ

General Provider Information

NPI Number	:	1700888088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSEMARIE R. CUNNINGHAM O.D.

Provider Business Mailing Address
First Line	:	907 N MAIN RD
Second Line	:	BLDG A
City	:	VINELAND
State	:	NJ
Zip	:	08360-8200
Country	:	US
Telephone Number	:	856-691-0720
Fax Number	:	856-691-6163

Provider Business Practice Location Address
First Line	:	907 N MAIN RD
Second Line	:	BLDG A
City	:	VINELAND
State	:	NJ
Zip	:	08360-8200
Country	:	US
Telephone Number	:	856-691-0720
Fax Number	:	856-691-6163

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/25/2010

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