Provider Demographics
NPI:1528117835
Name:MCCORMICK, MICHAEL
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 RESEARCH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4386
Mailing Address - Country:US
Mailing Address - Phone:512-258-2020
Mailing Address - Fax:512-258-7835
Practice Address - Street 1:12701 RESEARCH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4386
Practice Address - Country:US
Practice Address - Phone:512-258-2020
Practice Address - Fax:512-258-7835
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4838TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82909EOtherBCBS ID NUMBER
TX1216022002Medicaid
TX103130401Medicaid
TX82909EOtherBCBS ID NUMBER
TX00E37WMedicare ID - Type UnspecifiedPROVIDER ID