Provider Demographics
NPI:1366401812
Name:LAYCOCK, CYNTHIA A (O D)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:LAYCOCK
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:EASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-0286
Mailing Address - Country:US
Mailing Address - Phone:574-223-3916
Mailing Address - Fax:574-223-2965
Practice Address - Street 1:2260 MAIN ST.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975
Practice Address - Country:US
Practice Address - Phone:574-223-3916
Practice Address - Fax:574-223-2965
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003061A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200377630Medicaid
IN410049421Medicare PIN
IN410049420Medicare PIN
U81808Medicare UPIN
IN160450008Medicare PIN
IN199130BMedicare PIN