Provider Demographics
NPI:1134167018
Name:CUMMINGS, KORY SUE (OD)
Entity type:Individual
Prefix:DR
First Name:KORY
Middle Name:SUE
Last Name:CUMMINGS
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 1:1101 W ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4425
Mailing Address - Country:US
Mailing Address - Phone:817-294-4834
Mailing Address - Fax:817-423-7382
Practice Address - Street 1:1101 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4425
Practice Address - Country:US
Practice Address - Phone:817-294-4834
Practice Address - Fax:817-423-7382
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4963T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist