Provider Demographics
NPI:1477658870
Name:CUMBERLAND EYE CLINIC PA
Entity Type:Organization
Organization Name:CUMBERLAND EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-865-1860
Mailing Address - Street 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207
Mailing Address - Country:US
Mailing Address - Phone:615-865-1860
Mailing Address - Fax:615-865-1979
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207
Practice Address - Country:US
Practice Address - Phone:615-865-1860
Practice Address - Fax:615-865-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2001904OtherBCBS
3370685Medicare ID - Type Unspecified