Provider Demographics
NPI:1275759193
Name:KORY S. CUMMINGS, O.D., P.A.
Entity Type:Organization
Organization Name:KORY S. CUMMINGS, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-294-4834
Mailing Address - Street 1:4800 S HULEN ST STE 146
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1415
Mailing Address - Country:US
Mailing Address - Phone:817-294-4834
Mailing Address - Fax:817-294-4842
Practice Address - Street 1:4800 S HULEN ST STE 146
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1415
Practice Address - Country:US
Practice Address - Phone:817-294-4834
Practice Address - Fax:817-294-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4963T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00216ZMedicare ID - Type Unspecified