Provider Demographics
NPI:1649461286
Name:DR.ROBERT KUMMER,O.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR.ROBERT KUMMER,O.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-274-0653
Mailing Address - Street 1:1421 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3401
Mailing Address - Country:US
Mailing Address - Phone:310-274-0653
Mailing Address - Fax:310-274-0360
Practice Address - Street 1:1421 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3401
Practice Address - Country:US
Practice Address - Phone:310-274-0653
Practice Address - Fax:310-274-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5550 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055500Medicaid
CAT10032Medicare UPIN
CASD0055500Medicaid
CAWY6634Medicare PIN