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General NPI Number Information
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NPI Number | 1780876672
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Entity Type | Individual
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Provider Name | BRANDY MARIE MCCORMACK O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 9927 BROOK RD
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City | GLEN ALLEN
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State | VA
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Zip | 23059-6503
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Country | US
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Telephone | 804-955-4650
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Fax | 804-955-4655
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Provider Business Mailing Address
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Address Line | 8439 SWAN WOODS RD
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City | RHOADESVILLE
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State | VA
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Zip | 22542-8982
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Country | US
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Telephone | 562-882-3286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13324
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001914
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License Number State | VA
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