Provider Demographics
NPI:1689728792
Name:CUMMINGS, TIMOTHY JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:CUMMINGS
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 1:75 SAN MIGUEL AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3059
Mailing Address - Country:US
Mailing Address - Phone:831-757-7191
Mailing Address - Fax:831-771-2018
Practice Address - Street 1:75 SAN MIGUEL AVE
Practice Address - Street 2:STE 3
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3059
Practice Address - Country:US
Practice Address - Phone:831-757-7191
Practice Address - Fax:831-771-2018
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6195T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061950Medicaid
T10258Medicare UPIN
CASD0061950Medicaid