Provider Demographics
NPI:1518928274
Name:CUMMINGS, ROGER WILLIS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:WILLIS
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 EASTERN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1367
Mailing Address - Country:US
Mailing Address - Phone:336-768-3296
Mailing Address - Fax:336-760-5484
Practice Address - Street 1:190 KIMEL PARK DRIVE
Practice Address - Street 2:WINSTON-SALEM VA OUTPATIENT CLINIC
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4969
Practice Address - Country:US
Practice Address - Phone:336-768-3296
Practice Address - Fax:336-760-5484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1705152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT27590Medicare UPIN