Provider Demographics
NPI:1407296478
Name:CORNISH, KEATON C (OD)
Entity Type:Individual
Prefix:DR
First Name:KEATON
Middle Name:C
Last Name:CORNISH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6262
Mailing Address - Fax:641-752-7420
Practice Address - Street 1:6200 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7705
Practice Address - Country:US
Practice Address - Phone:515-327-6100
Practice Address - Fax:515-223-5468
Is Sole Proprietor?:No
Enumeration Date:2013-07-04
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA002590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist