Nicholas Corneillie, OD
NPI 1568196194ActiveIndividual· Optometrist· Hiram, GA
Optometrist (OD) with Mystic Medical LLC, practicing in Hiram, Georgia. Enrolled in Medicare as practitioner - optometry.
Overview
| NPI | 1568196194 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | OD |
| Sole proprietor | No |
| NPI issued | Jul 11, 2022 |
| Last updated in NPPES | Jul 11, 2022 |
| Certified by provider | Jul 11, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Optometrist Primary | 152W00000X | OPT003435 | GA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Optometry (GA) |
|---|
Education and affiliations
| Graduation year | 2022 |
|---|---|
| Medicare specialty | Optometry |
Medical group
- Mystic Medical LLCAtlanta, GA · 9 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
Other Optometrist providers in Hiram
- 1144468281
- 1235900887
- 1982060976
- 1649213471
- 1508101510
- 1407998388
- 1437644523
- 1265523823
- 1598589459
- 1801479068