Provider Demographics
NPI:1376650903
Name:ATKINSON, JOHN ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:ATKINSON
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 1:608 JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3660
Mailing Address - Country:US
Mailing Address - Phone:704-938-1135
Mailing Address - Fax:704-938-1200
Practice Address - Street 1:608 JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3660
Practice Address - Country:US
Practice Address - Phone:704-938-1135
Practice Address - Fax:704-938-1200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1271152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBC/BSOther0902B
NC890902BMedicaid
NCBC/BSOther0902B
NCT65066Medicare UPIN
NC28789Medicare ID - Type UnspecifiedHMO
NC0832160001Medicare ID - Type UnspecifiedPALMETTO GOVERMENT