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General NPI Number Information
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NPI Number | 1851969786
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Entity Type | Individual
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Provider Name | PATRICK MARTY KORMAN OD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 4330 EDISON LAKES PKWY STE A
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City | MISHAWAKA
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State | IN
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Zip | 46545-1446
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Country | US
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Telephone | 574-271-0120
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Fax | 574-273-4108
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Provider Business Mailing Address
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Address Line | 4330 EDISON LAKES PKWY STE A
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City | MISHAWAKA
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State | IN
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Zip | 46545-1446
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Country | US
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Telephone | 574-271-0120
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Fax | 574-273-4108
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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 | 3734
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License Number State | MN
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