Provider Demographics
NPI:1568469732
Name:KUMMER, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KUMMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3401
Mailing Address - Country:US
Mailing Address - Phone:310-274-0653
Mailing Address - Fax:310-274-0360
Practice Address - Street 1:1421 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3401
Practice Address - Country:US
Practice Address - Phone:310-274-0653
Practice Address - Fax:310-274-0360
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5550T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00361101OtherRAILROAD MEDICARE
CASD0055500Medicaid
CAP00361101OtherRAILROAD MEDICARE
CAWOP5550BMedicare PIN
CAT10032Medicare UPIN