Provider Demographics
NPI:1093935561
Name:CORNELL, ANTHONY FRANCIS
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANCIS
Last Name:CORNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 9W FAITH PLAZA
Mailing Address - Street 2:AFCORNELL OPTICIANS INC.
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AFCORNELL OPTICIANS, INC
Practice Address - Street 2:ROUTE 9W FAITH PLAZA
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143
Practice Address - Country:US
Practice Address - Phone:518-756-3135
Practice Address - Fax:518-756-2258
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004744-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
T26670Medicare UPIN
0846290001Medicare NSC
AA1696Medicare PIN