Individual
DR. JAMIE DALE CORNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
42D MEDICAL GROUP, 300 S. TWINING ST. BLDG. 760, MAXWELL AFB, AL 36113
(334) 953-3368
(334) 953-8607
Mailing address
42D MEDICAL GROUP, 300 S. TWINING ST. BLDG. 760, MAXWELL AFB, AL 36113
(334) 953-3368
(334) 953-8607
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1679
KS
152W00000X
Optometrist
Primary
18003253A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679
OPTOMETRY LICENSE
KS
01
—
18003253A
OPTOMETRY LICENSE
IN
Enumeration date
03/24/2006
Last updated
07/26/2021
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