Provider Demographics
NPI:1902833049
Name:MCCORMICK, CHERYL A (OD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6751 S MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-9148
Mailing Address - Country:US
Mailing Address - Phone:812-890-3306
Mailing Address - Fax:812-255-5449
Practice Address - Street 1:120 MAIN ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1234
Practice Address - Country:US
Practice Address - Phone:812-255-3003
Practice Address - Fax:812-255-5449
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001820A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34598Medicare UPIN