ANTIETAM EYE ASSOCIATES
NPI 1972733459
Optometrist in Waynesboro, PA

NPI Status: Active since July 20, 2009

Contact Information

1051 E MAIN ST
UNIT 7
WAYNESBORO, PA
ZIP 17268
Phone: (717) 387-5657
Fax: (717) 387-5638

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  • Organization
  • Optometrist
  • Accepts Insurance
  • Medicare Supplier
  • Accepts Medicare Approved Payment
  • CLIA Number: 39D2110412
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 03-14-2026

About ANTIETAM EYE ASSOCIATES

This page provides the complete NPI Profile along with additional information for Antietam Eye Associates, a provider established in Waynesboro, Pennsylvania operating as a Optometrist. The healthcare provider is registered in the NPI registry with number 1972733459 assigned on July 2009. The practitioner's primary taxonomy code is 152W00000X with license number OEG000994 (PA). The provider is registered as an organization and their NPI record was last updated 15 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Dr. Jerzy Kornilow O.d. (Optometrist)

NPI
1972733459
Provider Name
ANTIETAM EYE ASSOCIATES
Entity Type
Organization
Location Address
1051 E MAIN ST UNIT 7 WAYNESBORO, PA 17268
Location Phone
(717) 387-5657
Location Fax
(717) 387-5638
Mailing Address
1051 E MAIN ST UNIT 7 WAYNESBORO, PA 17268
Mailing Phone
(717) 387-5657
Mailing Fax
(717) 387-5638
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
07-20-2009
Last Update Date
03-23-2011
Code Navigator



Antietam Eye Associates is a medicare supplier with PTAN 20548187 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Prosthetic Lenses: Conventional Eyeglasses or Prosthetic Lenses: Conventional Contact Lenses.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Optometrist

Taxonomy Code
152W00000X
Type
Eye and Vision Services Providers
License No.
OEG000994
License State
PA
Taxonomy Description
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health� - EPO
  • BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health� - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

DR. JERZY KORNILOW O.D.

Authorized Official Title
OPTOMETRIST
Authorized Official Phone
(240) 217-4266

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN
20548187
Accepts Medicare Assignment
YES
Specialities List
Optometrist.
Competitive Bidding
NO

Supplies List

  • Prosthetic Lenses: Conventional Eyeglasses - Conventional Eyeglasses
  • Prosthetic Lenses: Conventional Contact Lenses - Conventional Contact Lenses

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
39D2110412
Facility Type
Physician Office
Certificate Effective Date
March 15, 2024
Certificate Expiration Date
March 14, 2026
Laboratory Director
DR. ALISON S. RIDENOUR
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Antietam Eye Associates to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for ANTIETAM EYE ASSOCIATES

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1972733459, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
9
Unchanged
Pos 3
7
Doubled → 14 → 1 + 4
Pos 4
2
Unchanged
Pos 5
7
Doubled → 14 → 1 + 4
Pos 6
3
Unchanged
Pos 7
3
Doubled → 6
Pos 8
4
Unchanged
Pos 9
5
Doubled → 10 → 1 + 0
Check
9
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 7 → 14 → 5 7 → 14 → 5 3 → 6 5 → 10 → 1

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 9 + 1 + 4 + 2 + 1 + 4 + 3 + 6 + 4 + 1 + 0 + 24 = 61

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 61 is 70. The difference is the calculated check digit.

70 - 61 = 9
This NPI is valid
The calculated check digit is 9, which matches the last digit of 1972733459.

Other Providers at the Same Location


The following 15 providers are registered at the same or a nearby location.

Family Medicine
1051 E MAIN ST, STE 1
WAYNESBORO, PA 17268
Family Medicine
1051 E MAIN ST, SUITE 1
WAYNESBORO, PA 17268
Internal Medicine
1051 E MAIN ST, SUITE #2
WAYNESBORO, PA 17268
Dentist (General Practice)
1051 E MAIN ST, SUITE 4
WAYNESBORO, PA 17268
Family Medicine
1051 E MAIN ST, SUITE 1
WAYNESBORO, PA 17268
Optometrist
1051 E MAIN ST, UNIT 7
WAYNESBORO, PA 17268
Internal Medicine
1051 E MAIN ST, SUITE #2
WAYNESBORO, PA 17268
Dentist (General Practice)
1051 E MAIN ST, STE 4
WAYNESBORO, PA 17268
Clinical Medical Laboratory
1051 E MAIN ST, SUITE 1
WAYNESBORO, PA 17268
Family Medicine
1051 E MAIN ST, STE 1
WAYNESBORO, PA 17268
Nurse Practitioner
1051 E MAIN ST, STE 1
WAYNESBORO, PA 17268
Nurse Practitioner (Family)
1051 E MAIN ST
WAYNESBORO, PA 17268
Family Medicine
1051 E MAIN ST, STE 1
WAYNESBORO, PA 17268
Internal Medicine
1051 E MAIN ST, SUITE 5
WAYNESBORO, PA 17268
Nurse Practitioner (Family)
1051 E MAIN ST
WAYNESBORO, PA 17268

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1972733459, enumerated as an "organization" on July 20, 2009.

The provider is located at 1051 E MAIN ST UNIT 7 WAYNESBORO, PA 17268 and the phone number is (717) 387-5657.

Optometrist with taxonomy code 152W00000X.

The provider might be accepting Accepts: BlueCross BlueShield of Tennessee. Please consult your insurance carrier or call the provider to verify.