Provider Demographics
NPI:1073762563
Name:CUNNINGHAM VISION CENTERS
Entity Type:Organization
Organization Name:CUNNINGHAM VISION CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-423-2148
Mailing Address - Street 1:138 W CHICAGO BLVD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1553
Mailing Address - Country:US
Mailing Address - Phone:517-423-2148
Mailing Address - Fax:517-423-2370
Practice Address - Street 1:138 W CHICAGO BLVD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1553
Practice Address - Country:US
Practice Address - Phone:517-423-2148
Practice Address - Fax:517-423-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0881850001Medicare NSC
MIT33083Medicare UPIN