Individual
BRETT B CORNELISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
524 W PUTNAM AVE, PORTERVILLE, CA 93257-3274
(559) 784-5127
(559) 784-4288
Mailing address
1577 BEDFORD AVE, CLOVIS, CA 93611-6607
(559) 784-5127
(559) 784-4288
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT9861T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0098610
—
CA
Enumeration date
11/22/2005
Last updated
08/20/2008
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