Provider Demographics
NPI:1396150512
Name:NORMAN, CAMERON (OD)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:NORMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E MAIN ST
Mailing Address - Street 2:P. O. BOX 275
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-1327
Mailing Address - Country:US
Mailing Address - Phone:765-564-2800
Mailing Address - Fax:765-564-2477
Practice Address - Street 1:750 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1327
Practice Address - Country:US
Practice Address - Phone:765-564-2800
Practice Address - Fax:765-564-2477
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003855A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201262540Medicaid
IN201262540Medicaid