Provider Demographics
NPI:1053670802
Name:CHARLES M. CUMMINS, OD, PA
Entity type:Organization
Organization Name:CHARLES M. CUMMINS, OD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-568-7680
Mailing Address - Street 1:PO BOX 846338
Mailing Address - Street 2:SPACE #8
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6338
Mailing Address - Country:US
Mailing Address - Phone:210-340-3531
Mailing Address - Fax:
Practice Address - Street 1:1907 DEPTFORD CENTER RD
Practice Address - Street 2:SPACE #8
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-5633
Practice Address - Country:US
Practice Address - Phone:856-232-5492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier