Provider Demographics
NPI:1972209393
Name:CUNNINGHAM, LANCE JR
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:CUNNINGHAM
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 N CANTON CENTER RD STE 270
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2614
Mailing Address - Country:US
Mailing Address - Phone:734-366-1665
Mailing Address - Fax:
Practice Address - Street 1:5840 N CANTON CENTER RD STE 270
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2614
Practice Address - Country:US
Practice Address - Phone:734-366-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist