Provider Demographics
NPI:1194760942
Name:MCCORMICK, ALAN J (OD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1851 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-858-3831
Mailing Address - Fax:316-858-3830
Practice Address - Street 1:5231 E CENTRAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4195
Practice Address - Country:US
Practice Address - Phone:316-683-6870
Practice Address - Fax:316-683-6873
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS202927OtherHPK
KS12973OtherPHS
KS17016OtherCOVENTRY
KS12149431OtherMULTIPLAN
KS100371210AMedicaid
KS650762OtherBCBS
KS17016OtherCOVENTRY
KS100371210AMedicaid