MEDICARE: DR. JOHN MCCORMICK JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2621TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82909E	OTHER	TX	BCBS PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	121602001	OTHER	TX	SUPERIOR HEALTH

General Provider Information

NPI Number	:	1871642173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MCCORMICK JR.

Provider Business Mailing Address
First Line	:	12701 RESEARCH BLVD
Second Line	:	STE 101
City	:	AUSTIN
State	:	TX
Zip	:	78759-4325
Country	:	US
Telephone Number	:	512-258-2020
Fax Number	:	512-258-7835

Provider Business Practice Location Address
First Line	:	12701 RESEARCH BLVD
Second Line	:	STE 101
City	:	AUSTIN
State	:	TX
Zip	:	78759-4325
Country	:	US
Telephone Number	:	512-258-2020
Fax Number	:	512-258-7835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	10/13/2010

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