Provider Demographics
NPI:1154462299
Name:CORCORAN, KEVIN L (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:925 HORSHAM ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2029
Mailing Address - Country:US
Mailing Address - Phone:267-991-6611
Mailing Address - Fax:215-674-4631
Practice Address - Street 1:925 HORSHAM ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2029
Practice Address - Country:US
Practice Address - Phone:267-991-6611
Practice Address - Fax:215-674-4631
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG000929152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28155Medicare UPIN