Active NPI
Jamie Dale Cornett, O.D.
- Optometrist
- Maxwell Afb, AL
National Provider Identifier
1164482956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18003253A
- Practice address
- 42D Medical Group
300 S. Twining St. BLDG. 760
Maxwell Afb, AL 36113 - Phone
- (334) 953-3368
- Fax
- (334) 953-8607
- NPI assigned
- Mar 24, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1679 | KS | |
| Optometrist | 152W00000X | 18003253A | IN | Primary |
Addresses
Primary practice location
42D Medical Group
300 S. Twining St. BLDG. 760
Maxwell Afb, AL 36113
Mailing address
42D Medical Group
300 S. Twining St. BLDG. 760
Maxwell Afb, AL 36113
Phone (334) 953-3368
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679 | Other | KS | OPTOMETRY LICENSE |
| 18003253A | Other | IN | OPTOMETRY LICENSE |
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 |
|---|---|---|---|
| 18003253A | IN | MD | Optometrist |
| 1679 | KS | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Tavel of Evansville, LLC | Optometrist | Past | Accepting new patients |
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.
-
- Optometrist
- Evansville, IN
- NPI 1205825700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627257600000",
"number": "1164482956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42D MEDICAL GROUP",
"address_2": "300 S. TWINING ST. BLDG. 760",
"city": "MAXWELL AFB",
"state": "AL",
"postal_code": "36113",
"telephone_number": "334-953-3368",
"fax_number": "334-953-8607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42D MEDICAL GROUP",
"address_2": "300 S. TWINING ST. BLDG. 760",
"city": "MAXWELL AFB",
"state": "AL",
"postal_code": "36113",
"telephone_number": "334-953-3368",
"fax_number": "334-953-8607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNETT",
"first_name": "JAMIE",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2021-07-26",
"certification_date": "2021-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KS",
"license": "1679",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18003253A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTOMETRY LICENSE",
"identifier": "1679",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTOMETRY LICENSE",
"identifier": "18003253A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maxwell Afb, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.