Provider Demographics
NPI:1598523201
Name:CUNNINGHAM, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:TAFTON
Mailing Address - State:PA
Mailing Address - Zip Code:18464-0308
Mailing Address - Country:US
Mailing Address - Phone:570-780-0657
Mailing Address - Fax:
Practice Address - Street 1:102 MT SNOW CIRCLE
Practice Address - Street 2:
Practice Address - City:TAFTON
Practice Address - State:PA
Practice Address - Zip Code:18464
Practice Address - Country:US
Practice Address - Phone:570-780-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier