Provider Demographics
NPI:1992763403
Name:CID, CYNTHIA A (OD)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:CID
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:GILLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2438 RESEARCH PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1094
Mailing Address - Country:US
Mailing Address - Phone:719-599-5083
Mailing Address - Fax:719-599-3291
Practice Address - Street 1:2438 RESEARCH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1094
Practice Address - Country:US
Practice Address - Phone:719-599-5083
Practice Address - Fax:719-599-3291
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82532389Medicaid
COC804479Medicare PIN
CO82532389Medicaid