Provider Demographics
NPI:1205916640
Name:MCCORMICK, LANNY LEE (OD)
Entity type:Individual
Prefix:DR
First Name:LANNY
Middle Name:LEE
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:487 SEASONS CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-9714
Mailing Address - Country:US
Mailing Address - Phone:970-256-1873
Mailing Address - Fax:970-256-1873
Practice Address - Street 1:1316 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6419
Practice Address - Country:US
Practice Address - Phone:970-245-6828
Practice Address - Fax:970-243-4046
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist