Provider Demographics
NPI:1154360428
Name:MCCORMICK, JOHN T (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:MCCORMICK
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4252
Mailing Address - Country:US
Mailing Address - Phone:207-563-3049
Mailing Address - Fax:207-563-3904
Practice Address - Street 1:5 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4252
Practice Address - Country:US
Practice Address - Phone:207-563-3049
Practice Address - Fax:207-563-3904
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT762A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME264110099Medicaid
MEU39526Medicare UPIN
ME264110099Medicaid
MEMCMM4697Medicare ID - Type Unspecified