Provider Demographics
NPI:1801972229
Name:NORMANDIE, CYNTHIA A (OD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:NORMANDIE
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 1:585 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1422
Mailing Address - Country:US
Mailing Address - Phone:508-755-3996
Mailing Address - Fax:
Practice Address - Street 1:1015 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520
Practice Address - Country:US
Practice Address - Phone:508-829-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15908OtherBLUE CROSS BLUE SHIELD
MA974707OtherNETWORK HEALTH
MA0354317Medicaid
726717OtherTUFTS HEALTH PLAN
8182729OtherCIGNA
MA974707OtherNETWORK HEALTH
MAW15908OtherBLUE CROSS BLUE SHIELD