Provider Demographics
NPI:1881785707
Name:CORNEY, RICHARD (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:CORNEY
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 1:240 US HIGHWAY 206 UNIT 5
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9244
Mailing Address - Country:US
Mailing Address - Phone:973-252-1119
Mailing Address - Fax:973-252-0248
Practice Address - Street 1:240 US HIGHWAY 206 UNIT 5
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9244
Practice Address - Country:US
Practice Address - Phone:973-252-1119
Practice Address - Fax:973-252-0248
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA-4768152W00000X
NJTO-000480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ602122Medicare ID - Type Unspecified
NJT77795Medicare UPIN