Provider Demographics
NPI:1699335182
Name:CORNELIA, HANNAH BERKLEY (OD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:BERKLEY
Last Name:CORNELIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 INDIGO MARKET DRIVE
Mailing Address - Street 2:312
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:678-602-5707
Mailing Address - Fax:
Practice Address - Street 1:8484 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7319
Practice Address - Country:US
Practice Address - Phone:843-767-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist