Individual
CHARLES OWEN MCCORMICK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 N EMERSON AVE, GREENWOOD, IN 46143-8895
(317) 881-3937
(317) 887-4008
Mailing address
30 N EMERSON AVE, GREENWOOD, IN 46143-8895
(317) 881-3937
(317) 887-4008
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01026314A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000011606
MPLAN
IN
01
—
000000214798
BCBS
IN
05
—
100154690
—
IN
01
—
154727
COLE VISION
IN
01
—
180044022
RAILROAD MEDICARE
IN
01
—
352129520
UNITED MINE WORKERS
IN
01
—
AETNA
AETNA
IN
Enumeration date
08/24/2005
Last updated
02/01/2010
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