Provider Demographics
NPI:1275650822
Name:CUMBERLAND OPTICAL
Entity Type:Organization
Organization Name:CUMBERLAND OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-722-4757
Mailing Address - Street 1:50 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2933
Mailing Address - Country:US
Mailing Address - Phone:301-722-4757
Mailing Address - Fax:
Practice Address - Street 1:50 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2933
Practice Address - Country:US
Practice Address - Phone:301-722-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0181070001Medicare NSC