Provider Demographics
NPI:1730133828
Name:CUNNINGHAM, SUSANNE STUMPF (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:STUMPF
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 5TH ST N
Mailing Address - Street 2:P.O. BOX 9099
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2203
Mailing Address - Country:US
Mailing Address - Phone:662-328-5225
Mailing Address - Fax:662-327-5950
Practice Address - Street 1:1823 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2203
Practice Address - Country:US
Practice Address - Phone:662-328-5225
Practice Address - Fax:662-327-5950
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSU94002Medicare UPIN
MS410000354Medicare ID - Type Unspecified