Provider Demographics
NPI:1528055118
Name:CYCOTTE, KAREN S (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:S
Last Name:CYCOTTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 S ROUTE 51
Mailing Address - Street 2:STE. B & C
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-8807
Mailing Address - Country:US
Mailing Address - Phone:217-875-7002
Mailing Address - Fax:217-875-7036
Practice Address - Street 1:849 S ROUTE 51
Practice Address - Street 2:STE. B & C
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-8807
Practice Address - Country:US
Practice Address - Phone:217-875-7002
Practice Address - Fax:217-875-7036
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04600007352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215175OtherBCBS
IL046007352Medicaid
IL0295700007Medicare NSC
IL046007352Medicaid
ILK04664Medicare PIN