Active NPI
Randall Perry Cummings, O.D.
- Optometrist
- Moscow, ID
National Provider Identifier
1215912472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- ODP-100097
- Practice address
- 1420 S Blaine St Ste 6
Moscow, ID 83843-3973 - Phone
- (208) 882-2020
- Fax
- (208) 882-2020
- NPI assigned
- Dec 9, 2005
- Last updated
- Oct 14, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODP-100097 | ID | Primary |
| Vision Therapy Optometrist | 152WV0400X | ODP - 100097 | ID |
Addresses
Primary practice location
1420 S Blaine St Ste 6
Moscow, ID 83843-3973
Mailing address
1420 S Blaine St Ste 6
Moscow, ID 83843-3973
Phone (208) 882-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807626700 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071031000517 | ID | Practitioner - Optometry | 3274620711 | Practice locations: Moscow, ID |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODP - 100097 | ID | MD | Vision Therapy Optometrist |
| 7170 | CA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255478400000",
"number": "1215912472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 S BLAINE ST STE 6",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838433973",
"telephone_number": "208-882-2020",
"fax_number": "208-882-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 S BLAINE ST STE 6",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838433973",
"telephone_number": "208-882-2020",
"fax_number": "208-882-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUMMINGS",
"first_name": "RANDALL",
"middle_name": "PERRY",
"name_prefix": "Mr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-09",
"last_updated": "2009-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ID",
"license": "ODP-100097",
"primary": true
},
{
"code": "152WV0400X",
"taxonomy_group": "",
"desc": "Optometrist, Vision Therapy",
"state": "ID",
"license": "ODP - 100097",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807626700",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.