Provider Demographics
NPI:1033258405
Name:CORNELL MCCOY, DIANE CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:CHRISTINE
Last Name:CORNELL MCCOY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:CHRISTINE
Other - Last Name:CORNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:60 EAST EVANS STREET
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-1123
Mailing Address - Country:US
Mailing Address - Phone:716-753-5142
Mailing Address - Fax:
Practice Address - Street 1:105 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1306
Practice Address - Country:US
Practice Address - Phone:716-793-2020
Practice Address - Fax:713-793-3030
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000794152W00000X
NYTUV004891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
47774Medicare UPIN
54875BMedicare ID - Type Unspecified