Individual provider Active NPI

James Charles Fornes , OD, O.D.

  • Optometrist
  • Green Bay, WI
National Provider Identifier
1265484042
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1465 Issued in WI
Practice address
301 Bay Park SQ
Green Bay, WI 54304-5104
Phone
(920) 499-3511
Fax
(920) 499-9215
NPI assigned
May 17, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1465 WI Primary

Addresses

Primary practice location

301 Bay Park SQ
Green Bay, WI 54304-5104

Mailing address

301 Bay Park SQ
Green Bay, WI 54304-5104
Phone (920) 499-3511

Other identifiers 1

IdentifierTypeStateIssuer
38504800MedicaidWI

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

LicenseStateTypeSpecialty
1465WIMDVeterinarian

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1265484042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 BAY PARK SQ",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045104",
            "telephone_number": "920-499-3511",
            "fax_number": "920-499-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 BAY PARK SQ",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045104",
            "telephone_number": "920-499-3511",
            "fax_number": "920-499-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNES , OD",
        "first_name": "JAMES",
        "middle_name": "CHARLES",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38504800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.