Individual provider Active NPI

John T McCormick, OD

  • Optometrist
  • Damariscotta, ME
National Provider Identifier
1154360428
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT762A Issued in ME
Practice address
5 Edwards Ave
Damariscotta, ME 04543-4252
Phone
(207) 563-3049
Fax
(207) 563-3904
NPI assigned
Jun 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT762A ME Primary

Addresses

Primary practice location

5 Edwards Ave
Damariscotta, ME 04543-4252

Mailing address

5 Edwards Ave
Damariscotta, ME 04543-4252
Phone (207) 563-3049

Other identifiers 1

IdentifierTypeStateIssuer
264110099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050705000214 ME Practitioner - Optometry 4183660871

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5 Edward Ave
Damariscotta, ME 04543-4252

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT762AMEMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
McCormick and Bouchard Eye Care, LLC Optometrist CurrentSince Mar 10, 1993 Accepting new patients

Locations

5 Edwards Ave
Damariscotta, ME 04543
Phone (207) 563-3049

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1154360428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 EDWARDS AVE",
            "city": "DAMARISCOTTA",
            "state": "ME",
            "postal_code": "045434252",
            "telephone_number": "207-563-3049",
            "fax_number": "207-563-3904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 EDWARDS AVE",
            "city": "DAMARISCOTTA",
            "state": "ME",
            "postal_code": "045434252",
            "telephone_number": "207-563-3049",
            "fax_number": "207-563-3904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "JOHN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ME",
            "license": "OPT762A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264110099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Damariscotta, ME

Sources for this page

Verify at the official NPI Registry.