Provider Demographics
NPI:1366467417
Name:CORRY, JAMES E (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:CORRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4412
Mailing Address - Country:US
Mailing Address - Phone:850-784-3937
Mailing Address - Fax:850-522-9829
Practice Address - Street 1:2500 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4412
Practice Address - Country:US
Practice Address - Phone:850-784-3937
Practice Address - Fax:850-522-9829
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP 1145152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19116OtherBLUE CROSS & BLUE SHIELD
FL19116EOtherMEDICARE
FL410042391OtherRR MEDICARE
FL078236000Medicaid
FL078236000Medicaid
FL19116OtherBLUE CROSS & BLUE SHIELD