Provider Demographics
NPI:1801847207
Name:CORNETT, JOHN TODD (OD,)
Entity Type:Individual
Prefix:
First Name:JOHN TODD
Middle Name:
Last Name:CORNETT
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 1:3635 S SONCY
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118
Mailing Address - Country:US
Mailing Address - Phone:806-356-6868
Mailing Address - Fax:806-351-0120
Practice Address - Street 1:3635 S SONCY
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-356-6868
Practice Address - Fax:806-351-0120
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4625TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00409729OtherRAILROAD
TX81972QOtherBCBS
TXU36383Medicare UPIN
TXP00409729OtherRAILROAD