Provider Demographics
NPI:1871502674
Name:CUNNINGHAM, JAMES K (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:CUNNINGHAM
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 1:700 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5614
Mailing Address - Country:US
Mailing Address - Phone:580-332-3936
Mailing Address - Fax:580-332-3939
Practice Address - Street 1:700 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5614
Practice Address - Country:US
Practice Address - Phone:580-332-3936
Practice Address - Fax:580-332-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK-2031152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761700AMedicaid
OK232721401Medicare PIN
OK100761700AMedicaid
OK0246520002Medicare NSC