Provider Demographics
NPI:1053763557
Name:CORKERY, MEGHAN (OD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:CORKERY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2315
Mailing Address - Country:US
Mailing Address - Phone:860-423-2565
Mailing Address - Fax:860-423-8058
Practice Address - Street 1:17 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-231-8482
Practice Address - Fax:860-231-8791
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 2524152WV0400X
CT3020152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy