Provider Demographics
NPI:1548609522
Name:CORMIER, ANDREW S (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:CORMIER
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:PO BOX 207151
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7151
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:8001 US HIGHWAY 19 N STE B
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1744
Practice Address - Country:US
Practice Address - Phone:727-954-7210
Practice Address - Fax:727-290-4177
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002809152W00000X
FLOPC4820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC4820OtherOPTOMETRY