Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicholas Corneillie, OD

Individual provider Optometrist · NPI 1568196194

Nicholas Corneillie, OD is an Optometry in Hiram, Georgia. Qualified in 2022, 4 years ago. Practices with Mystic Medical LLC, an 8-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
4
Licensed in
GA
In the registry since
2022
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

4465 Jimmy Lee Smith Pkwy Ste 101A
Hiram, GA 30141-2723
Phone: (678) 932-5779
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence OPT003435 (GA)

Record details

NPI number1568196194
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorNo
NPI enumeratedJuly 11, 2022
Last updated in NPPESJuly 11, 2022
Certification dateJuly 11, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Mystic Medical Llc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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