Provider Demographics
NPI:1780656306
Name:MCCORMICK, ROBERT PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:MCCORMICK
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 1:6157 ROUTE 20 E.
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084
Mailing Address - Country:US
Mailing Address - Phone:315-677-3193
Mailing Address - Fax:315-677-3196
Practice Address - Street 1:6157 ROUTE 20 E.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084
Practice Address - Country:US
Practice Address - Phone:315-677-3193
Practice Address - Fax:315-677-3196
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01808557Medicaid
BB7994Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
BB2081Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY01808557Medicaid