Provider Demographics
NPI:1184909210
Name:CUMMINGS, LAUREN DAVIS (OD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:DAVIS
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 1:15933 CLAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0838
Practice Address - Street 1:6096 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-5062
Practice Address - Country:US
Practice Address - Phone:850-623-4444
Practice Address - Fax:850-497-6219
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1649152W00000X
FLOPC4654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009168400Medicaid
FL190FKOtherFLORIDA BLUE
FLGG065ZMedicare PIN