Provider Demographics
NPI:1063630887
Name:KUMPITCH, PETER M (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:KUMPITCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5996
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5996
Mailing Address - Country:US
Mailing Address - Phone:340-778-4686
Mailing Address - Fax:340-778-0977
Practice Address - Street 1:ISLAND MEDICAL CENTER SUNNY ISLE
Practice Address - Street 2:4500 SION FERM
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-4686
Practice Address - Fax:340-778-0977
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI#6152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist