Provider Demographics
NPI:1568595791
Name:CUMMINS, JAMES W JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:CUMMINS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10225 AUSTIN DR STE 206
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1522
Mailing Address - Country:US
Mailing Address - Phone:619-670-0300
Mailing Address - Fax:619-670-5959
Practice Address - Street 1:9628 CAMPO RD
Practice Address - Street 2:STE C
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1233
Practice Address - Country:US
Practice Address - Phone:619-670-0350
Practice Address - Fax:619-670-5950
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 6016 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0060161Medicaid
CABN962AMedicare PIN
CAT70079Medicare UPIN
CA0685310001Medicare NSC