Provider Demographics
NPI:1730257809
Name:CUMMINGS, REX ALLEN (OD)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:ALLEN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1725
Mailing Address - Country:US
Mailing Address - Phone:304-273-5333
Mailing Address - Fax:304-273-5334
Practice Address - Street 1:105 ROYAL ST
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1725
Practice Address - Country:US
Practice Address - Phone:304-273-5333
Practice Address - Fax:304-273-5334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0679D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCU9179361Medicare ID - Type Unspecified
0603040001Medicare NSC
WVT32575Medicare UPIN