Organization
JIM CORNWELL O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIM CORNWELL O.D. (OWNER OPTOMETRIST)
(501) 240-2406
Entity
Organization
Contact information
Practice address
5501 KAVANAUGH BLVD, LITTLE ROCK, AR 72207-4614
(501) 240-2406
Mailing address
5501 KAVANAUGH BLVD, LITTLE ROCK, AR 72207-4614
(501) 240-2406
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2344
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48855
BLUE CROSS BLUE SHIELD
AR
Enumeration date
02/26/2007
Last updated
08/22/2020
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