Provider Demographics
NPI:1902863673
Name:CORCORAN, KEVIN T (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:CORCORAN
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 1:9711 MONTGOMERY ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-793-8486
Mailing Address - Fax:513-793-2023
Practice Address - Street 1:9711 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7257
Practice Address - Country:US
Practice Address - Phone:513-793-8486
Practice Address - Fax:513-793-2023
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT0023663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77540185Medicaid
OH000000108798OtherANTHEM
00000021016OtherBCBS
IN200023660Medicaid
OH0772810Medicaid
OH410030914OtherRAILROAD MEDICARE
OH0772810Medicaid
OH000000108798OtherANTHEM
T69311Medicare UPIN