=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194716928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. JAMES V. CORNETTA LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2005
-----------------------------------------------------
Last Update Date | 06/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 FORT LN
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23704-2220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-393-6131
-----------------------------------------------------
Fax | 757-393-0976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 FORT LN
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23704-2220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-393-6131
-----------------------------------------------------
Fax | 757-393-0976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES V CORNETTA
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 757-393-6131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1689665861
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------