MEDICARE: DR. KAREN S CYCOTTE 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	04600007352	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7215175	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528055118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN S CYCOTTE O.D.

Provider Business Mailing Address
First Line	:	849 S ROUTE 51
Second Line	:	STE. B & C
City	:	FORSYTH
State	:	IL
Zip	:	62535-8807
Country	:	US
Telephone Number	:	217-875-7002
Fax Number	:	217-875-7036

Provider Business Practice Location Address
First Line	:	849 S ROUTE 51
Second Line	:	STE. B & C
City	:	FORSYTH
State	:	IL
Zip	:	62535-8807
Country	:	US
Telephone Number	:	217-875-7002
Fax Number	:	217-875-7036

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	09/29/2009

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