Provider Demographics
NPI:1295821148
Name:MCLYMAN, CINNAMON A (ABOC)
Entity Type:Individual
Prefix:
First Name:CINNAMON
Middle Name:A
Last Name:MCLYMAN
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3578
Mailing Address - Country:US
Mailing Address - Phone:607-753-7528
Mailing Address - Fax:607-756-8163
Practice Address - Street 1:1160 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3578
Practice Address - Country:US
Practice Address - Phone:607-753-7528
Practice Address - Fax:607-756-8163
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006144156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5768320001Medicare NSC