Jim Cornwell O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2344 Issued in AR

Legal business name

JIM CORNWELL O.D.

Practice address

5501 Kavanaugh Blvd
Little Rock, AR 72207-4614

Phone

(501) 240-2406

NPI assigned

Feb 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jim Cornwell, O.D.

Title

Owner Optometrist

Phone

(501) 240-2406

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831225887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 KAVANAUGH BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722074614",
            "telephone_number": "501-240-2406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 KAVANAUGH BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722074614",
            "telephone_number": "501-240-2406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM CORNWELL O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CORNWELL",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "OWNER OPTOMETRIST",
        "authorized_official_telephone_number": "501-240-2406",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "48855",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kayla Jimmerson
• Robert Tyray Jimmerson II, M.D.

• Optometrist in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.