Kenneth David Cornwall, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT003524 Issued in GA

Practice address

3240 S Cobb Dr SE Ste 1000
Smyrna, GA 30080-4112

Phone

(770) 701-3051

NPI assigned

Aug 14, 2023

Last updated

Aug 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ga Doctors of Optometry LLC

  • Optometrist
  • Lithonia, GA
  • NPI 1174105936
  Medicare reassignment NPD
• Ga Doctors of Optometry LLC

  • Eyewear Supplier
  • Columbus, GA
  • NPI 1013599745

  Optometrist

  NPD
• National Vision, Inc.

  dba America's Best Contacts & Eyeglasses

  • Optician
  • Smyrna, GA
  • NPI 1356893341
  NPD (past)

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1629851886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2735 PACES FERRY RD SE APT 413",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303397639",
            "telephone_number": "404-783-2208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 S COBB DR SE STE 1000",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300804112",
            "telephone_number": "770-701-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNWALL",
        "first_name": "KENNETH",
        "middle_name": "DAVID",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Thomas Cooper, PH.D.
• Jocelyn Copeland, PHARMD
• Cora Lee Institute
• Corecare Solutions, LLC
• Cornerstone Behavioral Health, LLC
• Abigail Sophia Corona, CCC-SLP
• J A Corso, MD
• Emily May Cortes-Rendini, MS, APC
• Cheryl Scarbrough Cosey, LPC
• Guilherme De Morais Melo Costa, MD

• Optometrist in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.