Cornelius J Shaneyfelt, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18001864B Issued in IN

Practice address

12 N Jefferson St
Knightstown, IN 46148-1243

Phone

(765) 345-5405

Fax

(765) 345-5405

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Indiana University - School of Optometry, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226361600000",
    "number": "1962556118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25",
            "city": "KNIGHTSTOWN",
            "state": "IN",
            "postal_code": "461480025",
            "telephone_number": "765-345-5405",
            "fax_number": "765-345-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 N JEFFERSON ST",
            "city": "KNIGHTSTOWN",
            "state": "IN",
            "postal_code": "461481243",
            "telephone_number": "765-345-5405",
            "fax_number": "765-345-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANEYFELT",
        "first_name": "CORNELIUS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2008-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001864B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100183230A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tam Pham, D.D.S.
• Nicole Phelps, COTA
• Amy Meyer Ploeger, DDS
• Richard a Armstrong DDS, PC
• Aimee Rodeghero, MA, CCC-SLP
• Southwest Districk Ambulance Service Inc
• State of Indiana
• Benjamin Wright

• Optometrist in Knightstown, IN
• Providers in Knightstown, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; 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.