Provider Demographics
NPI:1871642173
Name:MCCORMICK, JOHN JR
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MCCORMICK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 RESEARCH BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4325
Mailing Address - Country:US
Mailing Address - Phone:512-258-2020
Mailing Address - Fax:512-258-7835
Practice Address - Street 1:12701 RESEARCH BLVD
Practice Address - Street 2:STE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4325
Practice Address - Country:US
Practice Address - Phone:512-258-2020
Practice Address - Fax:512-258-7835
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2621TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82909EOtherBCBS PROVIDER ID
TX121602001Medicaid
TX121675601Medicaid
TX121602001OtherSUPERIOR HEALTH
TX82909EOtherBCBS PROVIDER ID
TXU51857Medicare UPIN