Active NPI
Craig Manwell McCormick, O.D.
- Optometrist
- Albert Lea, MN
National Provider Identifier
1902885171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2226
- Practice address
- 404 W Fountain St
Albert Lea, MN 56007-2437 - Phone
- (507) 373-2384
- NPI assigned
- Jan 16, 2006
- Last updated
- Jun 27, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2226 | MN | Primary |
Addresses
Primary practice location
404 W Fountain St
Albert Lea, MN 56007-2437
Mailing address
19578 724TH Ave
Albert Lea, MN 56007-5577
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 599323700 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02099 | IA | MD | Physical Therapist |
| 2226 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340755200000",
"number": "1902885171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19578 724TH AVE",
"city": "ALBERT LEA",
"state": "MN",
"postal_code": "560075577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 W FOUNTAIN ST",
"city": "ALBERT LEA",
"state": "MN",
"postal_code": "560072437",
"telephone_number": "507-373-2384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "CRAIG",
"middle_name": "MANWELL",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-16",
"last_updated": "2012-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2226",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "599323700",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albert Lea, MN
- Mayo Clinic Health System-Southeast Minnesota Region (Mayo Clinic Health System - Albert Lea)
- Mayo Clinic Health System-Southeast Minnesota Region (Mayo Clinic Health System-Albert Lea and Austin)
- Mayo Clinic Health System-Southeast Minnesota Region (Fountain Centers)
- Mayo Clinic Hospital-Rochester
- Mayo Foundation for Medical Education & Research (Mayo Clinic Store-Albert Lea)
- Barbara Jo Meek-Thue, R.N. C.N.P.
- Carla Marie Mehelich-Ubben, PA-C
- Mercy Health Services- Iowa Corp (MercyOne Albert Lea Home Medical Shop)
- Angela L Meyer, O.T.
- Craig Meyer, PTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.