Active NPI
Brett B Cornelison, OD
- Optometrist
- Porterville, CA
National Provider Identifier
1568445658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT9861T
- Practice address
- 524 W Putnam Ave
Porterville, CA 93257-3274 - Phone
- (559) 784-5127
- Fax
- (559) 784-4288
- NPI assigned
- Nov 22, 2005
- 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 | OPT9861T | CA | Primary |
Addresses
Primary practice location
524 W Putnam Ave
Porterville, CA 93257-3274
Mailing address
1577 Bedford Ave
Clovis, CA 93611-6607
Phone (559) 784-5127
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0098610 | Medicaid | CA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT9861T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219190400000",
"number": "1568445658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1577 BEDFORD AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936116607",
"telephone_number": "559-784-5127",
"fax_number": "559-784-4288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "524 W PUTNAM AVE",
"city": "PORTERVILLE",
"state": "CA",
"postal_code": "932573274",
"telephone_number": "559-784-5127",
"fax_number": "559-784-4288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELISON",
"first_name": "BRETT",
"middle_name": "B",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-22",
"last_updated": "2008-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT9861T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0098610",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Porterville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.