Provider Demographics
NPI:1679673495
Name:MARTINSVILLE VISION CLINIC PC
Entity Type:Organization
Organization Name:MARTINSVILLE VISION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:B
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-342-6654
Mailing Address - Street 1:219 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1554
Mailing Address - Country:US
Mailing Address - Phone:765-342-6654
Mailing Address - Fax:765-342-0418
Practice Address - Street 1:219 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1554
Practice Address - Country:US
Practice Address - Phone:765-342-6654
Practice Address - Fax:765-342-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001572B152W00000X
IN18002989B152W00000X
IN18003161B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1881693547OtherKELLY CUNNINGHAM NPI
IN200242470AMedicaid
IN1023017639OtherTHEODORE REX LEGLER II NPI
IN200076560AMedicaid
IN200242380AMedicaid
IN200341850AMedicaid
IN1871592535OtherAARON CUNNINGHAM NPI
IN1881693547OtherKELLY CUNNINGHAM NPI
INU77949Medicare UPIN
IN200076560AMedicaid
INU57578Medicare UPIN