NPIMap

Organization Active NPI

Antietam Eye Associates

  • Optometrist
  • Waynesboro, PA
National Provider Identifier
1972733459
Registry record updated Mar 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000994 Issued in PA
Legal business name
ANTIETAM EYE ASSOCIATES
Practice address
1051 E Main St
Unit 7
Waynesboro, PA 17268-2318
Phone
(717) 387-5657
Fax
(717) 387-5638
NPI assigned
Jul 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2011

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

Authorized official

Name
Dr. Jerzy Kornilow, O.D.
Title
Optometrist
Phone
(240) 217-4266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OEG000994 PA Primary

Addresses

Primary practice location

1051 E Main St
Unit 7
Waynesboro, PA 17268-2318

Mailing address

1051 E Main St
Unit 7
Waynesboro, PA 17268-2318
Phone (717) 387-5657

National Provider Directory

National Provider Directory

Locations

1051 E Main St
Ste 7
Waynesboro, PA 17268
Phone (240) 217-4266

NPI Registry JSON

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1972733459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 E MAIN ST",
            "address_2": "UNIT 7",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682318",
            "telephone_number": "717-387-5657",
            "fax_number": "717-387-5638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 E MAIN ST",
            "address_2": "UNIT 7",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682318",
            "telephone_number": "717-387-5657",
            "fax_number": "717-387-5638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIETAM EYE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-20",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "KORNILOW",
        "authorized_official_first_name": "JERZY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "240-217-4266",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; 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.