Provider Demographics
NPI:1568632644
Name:KEVIN L. CORCORAN, OD, PC
Entity Type:Organization
Organization Name:KEVIN L. CORCORAN, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-675-2404
Mailing Address - Street 1:925 HORSHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044
Mailing Address - Country:US
Mailing Address - Phone:215-675-2404
Mailing Address - Fax:215-672-0748
Practice Address - Street 1:925 HORSHAM ROAD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044
Practice Address - Country:US
Practice Address - Phone:215-675-2404
Practice Address - Fax:215-672-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000929152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty