Provider Demographics
NPI:1518198803
Name:DR CHERYL MCCORMICK OPTOMETRIST, PC
Entity Type:Organization
Organization Name:DR CHERYL MCCORMICK OPTOMETRIST, PC
Other - Org Name:INSIGHT OF THE WABASH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-255-3003
Mailing Address - Street 1:120 MAIN ST
Mailing Address - Street 2:PO BOX 963
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1234
Mailing Address - Country:US
Mailing Address - Phone:812-255-3003
Mailing Address - Fax:812-255-5449
Practice Address - Street 1:120 MAIN ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1234
Practice Address - Country:US
Practice Address - Phone:812-255-3003
Practice Address - Fax:812-255-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001820A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1902833049Medicaid
IN200965440Medicaid
1518198803Medicare NSC
IN200965440Medicaid