Provider Demographics
NPI:1427000389
Name:PURNELL, ROBERT SCHORN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCHORN
Last Name:PURNELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1711
Mailing Address - Country:US
Mailing Address - Phone:201-939-2463
Mailing Address - Fax:201-939-1454
Practice Address - Street 1:31 PARK AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1711
Practice Address - Country:US
Practice Address - Phone:201-939-2463
Practice Address - Fax:201-939-1454
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ05447152W00000X, 152WC0802X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7714106Medicaid
NJU64155Medicare UPIN
NJPU506150Medicare ID - Type Unspecified