Provider Demographics
NPI:1538200639
Name:LAFAYETTE FAMILY OPTOMETRY PLLC
Entity type:Organization
Organization Name:LAFAYETTE FAMILY OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-677-3193
Mailing Address - Street 1:6157 US ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-3404
Mailing Address - Country:US
Mailing Address - Phone:315-677-3193
Mailing Address - Fax:315-677-3196
Practice Address - Street 1:6157 RT 20 E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084
Practice Address - Country:US
Practice Address - Phone:315-677-3193
Practice Address - Fax:315-677-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0619OtherPTAN
NY0271390001Medicare NSC