Provider Demographics
NPI:1578979209
Name:MCCORMACK, REBECCA SHAPIRO (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SHAPIRO
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:JEAN
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 LONGKEEP LN
Mailing Address - Street 2:APT 114
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-6319
Mailing Address - Country:US
Mailing Address - Phone:434-825-1910
Mailing Address - Fax:
Practice Address - Street 1:2070 SAM RITTENBERG BLVD
Practice Address - Street 2:OFFICE B200
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4605
Practice Address - Country:US
Practice Address - Phone:843-556-8844
Practice Address - Fax:843-556-9335
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002338152W00000X
SC1969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist