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General NPI Number Information
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NPI Number | 1831225887
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Entity Type | Organization
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Legal Business Name | JIM CORNWELL O.D.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5501 KAVANAUGH BLVD
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4614
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Country | US
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Telephone | 501-240-2406
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 KAVANAUGH BLVD
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4614
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Country | US
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Telephone | 501-240-2406
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Fax |
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. JIM CORNWELL
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Credential | O.D.
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Telephone | 501-240-2406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2344
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License Number State | AR
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