Provider Demographics
NPI:1952367211
Name:CUMBERLAND PROSTHETICS, INC
Entity Type:Organization
Organization Name:CUMBERLAND PROSTHETICS, INC
Other - Org Name:RICHARDSON OCULAR PROSTHETIC, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCO, BADO
Authorized Official - Phone:615-321-5611
Mailing Address - Street 1:329 21ST AVE N STE 2
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1855
Mailing Address - Country:US
Mailing Address - Phone:615-321-5611
Mailing Address - Fax:615-327-3871
Practice Address - Street 1:329 21ST AVE N STE 2
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1855
Practice Address - Country:US
Practice Address - Phone:615-321-5611
Practice Address - Fax:615-327-3871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455015Medicaid
TN5621240001Medicare ID - Type Unspecified