Active NPI
Ronald J Fornelli, OD
- Optometrist
- Blue Springs, MO
National Provider Identifier
1104970243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T02154
- Practice address
- 3417 NW Mill Dr
Blue Springs, MO 64015-3257 - Phone
- (816) 229-3001
- Fax
- (816) 229-9459
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | T02154 | MO | Primary |
Addresses
Primary practice location
3417 NW Mill Dr
Blue Springs, MO 64015-3257
Mailing address
3417 NW Mill Dr
Blue Springs, MO 64015-3257
Phone (816) 229-3001
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 |
|---|---|---|---|
| T02154 | MO | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242172800000",
"number": "1104970243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3417 NW MILL DR",
"city": "BLUE SPRINGS",
"state": "MO",
"postal_code": "640153257",
"telephone_number": "816-229-3001",
"fax_number": "816-229-9459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3417 NW MILL DR",
"city": "BLUE SPRINGS",
"state": "MO",
"postal_code": "640153257",
"telephone_number": "816-229-3001",
"fax_number": "816-229-9459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORNELLI",
"first_name": "RONALD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2009-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T02154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blue Springs, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.