Ilyse Samantha Kornblau, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

59116 Issued in TN

Practice address

4500 S Lancaster Rd
Dallas, TX 75216-7167

Phone

(214) 742-8387

Fax

(214) 857-2828

NPI assigned

Apr 10, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• University of Miami

  • Ambulatory Surgical Clinic/Center
  • Palm Beach Gardens, FL
  • NPI 1346317039
  NPD (past)

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1720407372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 S LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752167167",
            "telephone_number": "214-742-8387",
            "fax_number": "214-857-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 S LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752167167",
            "telephone_number": "214-742-8387",
            "fax_number": "214-857-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNBLAU",
        "first_name": "ILYSE",
        "middle_name": "SAMANTHA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-10",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TN",
            "license": "59116",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "HSE26017",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "BP20054251",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Korbus
• Korean Home Health Care Inc
• Adam Shane Korenke, PA C
• Joan Elizabeth Koritni, RN
• Crystal Harley Kornak, NNP-BC
• Grace Kornegay
• Irwin Steven Korngut, M.D.
• Nabeel Samir Koro, M.D.
• Deeba Korous, NP
• Jonathan Ryan Korpon

• Ophthalmology Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Ophthalmology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.