MEDICARE: DR. KEITH LYNDON MCCORMICK M.D.

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	207W00000X	Ophthalmology Physician	9501600	NC
2	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	9501600	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912970815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH LYNDON MCCORMICK M.D.

Provider Business Mailing Address
First Line	:	2047 VALLEYGATE DRIVE
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3688
Country	:	US
Telephone Number	:	910-485-3937
Fax Number	:	910-221-3672

Provider Business Practice Location Address
First Line	:	2047 VALLEYGATE DRIVE
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3688
Country	:	US
Telephone Number	:	910-485-3937
Fax Number	:	910-221-3672

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	05/31/2024

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Directions to “ DR. KEITH LYNDON MCCORMICK M.D.” Practice Location

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