Provider Demographics
NPI:1669253548
Name:CUNNINGHAM, LLOYD ANTHONEY SR (ABO)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:ANTHONEY
Last Name:CUNNINGHAM
Suffix:SR
Gender:M
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3055
Mailing Address - Country:US
Mailing Address - Phone:510-778-8709
Mailing Address - Fax:
Practice Address - Street 1:3109 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-3055
Practice Address - Country:US
Practice Address - Phone:510-778-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
CARDO71254156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician