| |
120 Main St Vincennes IN 47591-1234 | |
(812) 255-3003 | |
(812) 255-5449 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 120 Main St, Vincennes, Indiana |
Authorized Official Name and Position | Cheryl A Mccormick (OWNER/PRESIDENT) |
Authorized Official Contact | 8122553003 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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120 Main St Po Box 963 Vincennes IN 47591-1234 Ph: (812) 255-3003 | 120 Main St Vincennes IN 47591-1234 Ph: (812) 255-3003 |
NPI Number | 1518198803 |
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Provider Enumeration Date | 08/04/2009 |
Last Update Date | 03/10/2010 |
Medicare PECOS PAC ID | 0446304042 |
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Medicare Enrollment ID | O20090817000495 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518198803 | NPI | - | NPPES |
1902833049 | Medicaid | IN | |
200965440 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 18001820A (Indiana) | Primary |
Provider Name | Cheryl A Mccormick |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1902833049 PECOS PAC ID: 5092869693 Enrollment ID: I20090817000484 |
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