Provider Demographics
NPI:1346630324
Name:STACIE ATKINS, O.D., P.A.
Entity Type:Organization
Organization Name:STACIE ATKINS, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-577-5324
Mailing Address - Street 1:130 NW JOHN JONES DR
Mailing Address - Street 2:SUITE 216A
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5145
Mailing Address - Country:US
Mailing Address - Phone:817-295-0100
Mailing Address - Fax:817-295-5586
Practice Address - Street 1:130 NW JOHN JONES DR
Practice Address - Street 2:SUITE 216A
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5145
Practice Address - Country:US
Practice Address - Phone:817-295-0100
Practice Address - Fax:817-295-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5948T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU99629Medicare UPIN