Provider Demographics
NPI:1154326528
Name:KERNODLE, JAMES M JR (OD PA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:KERNODLE
Suffix:JR
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 A N. FAYETTEVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5531
Mailing Address - Country:US
Mailing Address - Phone:336-625-2020
Mailing Address - Fax:336-629-2030
Practice Address - Street 1:328 A N. FAYETTEVILLE STREET
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5531
Practice Address - Country:US
Practice Address - Phone:336-625-2020
Practice Address - Fax:336-629-2030
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-09-24
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NC1764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0926AOtherBCBSNC
NC890926AMedicare ID - Type Unspecified
NC2471729DMedicare ID - Type Unspecified
NCU77929Medicare UPIN
NC0926AOtherBCBSNC
NC2471729CMedicare ID - Type Unspecified
NC2471729BMedicare ID - Type Unspecified