Provider Demographics
NPI:1427016435
Name:CONEKIN, GEORGE M III (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:CONEKIN
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:200 DOCTORS DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6308
Mailing Address - Country:US
Mailing Address - Phone:910-353-0541
Mailing Address - Fax:910-353-5353
Practice Address - Street 1:200 DOCTORS DR
Practice Address - Street 2:SUITE K
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-353-0541
Practice Address - Fax:910-353-5353
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1181152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09328OtherBCBS ID#
NC7909328Medicaid
NC170000072OtherRAILROAD MEDICARE ID#
NC561719600OtherTRICARE/HEALTH NET ID#
NCY1605OtherBLIND COMMISSION ID#
NC7909328Medicaid
NC0131800001Medicare NSC
NC246645Medicare ID - Type Unspecified