Provider Demographics
NPI:1780757047
Name:CUNNINGAHM, DANIEL JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:CUNNINGAHM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1348 TRAVIS VIEW CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3313
Mailing Address - Country:US
Mailing Address - Phone:240-683-8587
Mailing Address - Fax:
Practice Address - Street 1:6509 DEMOCRACY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1639
Practice Address - Country:US
Practice Address - Phone:301-897-8484
Practice Address - Fax:301-897-8486
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1913152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV03128Medicare UPIN