MEDICARE: MR. CHARLES L. CUMMINGS

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	156FX1800X	Optician	09658	AL

General Provider Information

NPI Number	:	1710053053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES L. CUMMINGS

Provider Business Mailing Address
First Line	:	306 COLISEUM BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2712
Country	:	US
Telephone Number	:	334-272-2115
Fax Number	:	334-270-8383

Provider Business Practice Location Address
First Line	:	306 COLISEUM BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2712
Country	:	US
Telephone Number	:	334-272-2115
Fax Number	:	334-270-8383

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. CHARLES L. CUMMINGS ” Practice Location

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