Healthcare Provider Details

I. General information

NPI: 1912970815
Provider Name (Legal Business Name): KEITH LYNDON MCCORMICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 N SILVERBELL RD STE 355
TUCSON AZ
85745-2981
US

IV. Provider business mailing address

2177 W ORANGE GROVE RD
TUCSON AZ
85741-3118
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-3487
  • Fax: 520-327-3488
Mailing address:
  • Phone: 520-327-3487
  • Fax: 520-327-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number79362
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number79362
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: