Basic Information
| Provider Information | |||||||||
| NPI: | 1780876672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCORMACK | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8439 SWAN WOODS RD | ||||||||
| Address2: | |||||||||
| City: | RHOADESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225428982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628823286 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9927 BROOK RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230596503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049554650 | ||||||||
| FaxNumber: | 8049554655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 07/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 13324 | CA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618001914 | VA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.