Provider Demographics
NPI:1366971574
Name:KOMORNIK, JAMES RONALD (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RONALD
Last Name:KOMORNIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 E OCEAN VIEW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-1612
Mailing Address - Country:US
Mailing Address - Phone:757-355-5553
Mailing Address - Fax:
Practice Address - Street 1:4035 E OCEAN VIEW AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-1612
Practice Address - Country:US
Practice Address - Phone:757-355-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002581152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist