Provider Demographics
NPI:1700888088
Name:CUNNINGHAM, ROSEMARIE R (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:R
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:907 N MAIN RD
Mailing Address - Street 2:BLDG A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8200
Mailing Address - Country:US
Mailing Address - Phone:856-691-0720
Mailing Address - Fax:856-691-6163
Practice Address - Street 1:907 N MAIN RD
Practice Address - Street 2:BLDG A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8200
Practice Address - Country:US
Practice Address - Phone:856-691-0720
Practice Address - Fax:856-691-6163
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA03028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU08537Medicare UPIN
NJ407782Medicare ID - Type Unspecified