Provider Demographics
NPI:1184637001
Name:ATKINS, BRIAN (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ATKINS
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 1:3101 SW COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8459
Mailing Address - Country:US
Mailing Address - Phone:352-237-3768
Mailing Address - Fax:352-237-4595
Practice Address - Street 1:3968 SW ARCHER RD # W101
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2342
Practice Address - Country:US
Practice Address - Phone:352-376-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0494Medicare ID - Type Unspecified
FLU94766Medicare UPIN