Provider Demographics
NPI:1619960986
Name:CUNDIFF, HARRY CLAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:CLAY
Last Name:CUNDIFF
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:H
Other - Middle Name:CLAY
Other - Last Name:CUNDIFF
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4801 S CLIFF AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7015
Mailing Address - Country:US
Mailing Address - Phone:816-478-1230
Mailing Address - Fax:816-478-4413
Practice Address - Street 1:4741 S COCHISE DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6974
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:816-478-4413
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR6424207W00000X
KS04-26370207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4060302Medicare PIN
A11883Medicare UPIN