Individual
MR. RANDALL PERRY CUMMINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1420 S BLAINE ST STE 6, MOSCOW, ID 83843-3973
(208) 882-2020
(208) 882-2020
Mailing address
1420 S BLAINE ST STE 6, MOSCOW, ID 83843-3973
(208) 882-2020
(208) 882-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100097
ID
152WV0400X
Vision Therapy Optometrist
ODP - 100097
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807626700
—
ID
Enumeration date
12/09/2005
Last updated
10/14/2009
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