MEDICARE: DR. ROBERT MICHAEL CORCORAN O.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	152W00000X	Optometrist	OEG00639	PA

General Provider Information

NPI Number	:	1467426973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MICHAEL CORCORAN O.D.

Provider Business Mailing Address
First Line	:	3736 CONDUIT RD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2630
Country	:	US
Telephone Number	:	570-472-1924
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 24TH ST
Second Line	:
City	:	FORT GREGG ADAMS
State	:	VA
Zip	:	23801-1716
Country	:	US
Telephone Number	:	804-734-9253
Fax Number	:	804-734-9248

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/04/2023

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