Provider Demographics
NPI:1881165611
Name:MCCORMICK, JOSHUA EDWARD
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:EDWARD
Last Name:MCCORMICK
Suffix:
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 1:4238 RECREATION DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2235
Mailing Address - Country:US
Mailing Address - Phone:585-393-0510
Mailing Address - Fax:
Practice Address - Street 1:4238 RECREATION DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2235
Practice Address - Country:US
Practice Address - Phone:585-393-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1202X
NY010439-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician