Provider Demographics
NPI:1194716928
Name:DR. JAMES V. CORNETTA LTD
Entity type:Organization
Organization Name:DR. JAMES V. CORNETTA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:CORNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-393-6131
Mailing Address - Street 1:226 FORT LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2220
Mailing Address - Country:US
Mailing Address - Phone:757-393-6131
Mailing Address - Fax:757-393-0976
Practice Address - Street 1:226 FORT LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2220
Practice Address - Country:US
Practice Address - Phone:757-393-6131
Practice Address - Fax:757-393-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1689665861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA200002OtherOPTIMA
VA200002OtherOPTIMA
VA5519730001Medicare NSC
VAC05859Medicare PIN