Provider Demographics
NPI:1427029099
Name:CORMIER, ELAINE L (OD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:L
Last Name:CORMIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422
Mailing Address - Country:US
Mailing Address - Phone:805-466-3777
Mailing Address - Fax:805-466-3700
Practice Address - Street 1:7605 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422
Practice Address - Country:US
Practice Address - Phone:805-466-3777
Practice Address - Fax:805-466-3700
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8951T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0089510Medicaid
CA410031525OtherRAILROAD MEDICARE
CA410031525OtherRAILROAD MEDICARE
U34150Medicare UPIN
CA410031525OtherRAILROAD MEDICARE