Individual
DEREK N. CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
901 MOPAC EXPRESSWAY SOUTH, BUILDING 4 SUITE 350, AUSTIN, TX 78746-5776
(512) 347-0255
(512) 347-0785
Mailing address
901 MOPAC EXPRESSWAY SOUTH, BUILDING 4 SUITE 350, AUSTIN, TX 78746-5776
(512) 347-0255
(512) 347-0785
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
06300T
TX
152W00000X
Optometrist
R164TA776
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166400501
—
TX
Enumeration date
02/23/2006
Last updated
10/21/2014
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