MEDICARE: DR. KAREN S. CYCOTTE, OD, LLC

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	046007352	IL

General Provider Information

NPI Number	:	1558695429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. KAREN S. CYCOTTE, OD, LLC

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

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

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KAREN SUE CYCOTTE
Credential	:	O.D.
Telephone Number	:	217-875-7002

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/25/2009

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