Provider Demographics
NPI:1487668562
Name:ADKINS, JACK DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:DAVID
Last Name:ADKINS
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 1:5020 W SAGINAW HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2625
Mailing Address - Country:US
Mailing Address - Phone:517-323-3399
Mailing Address - Fax:
Practice Address - Street 1:5020 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2625
Practice Address - Country:US
Practice Address - Phone:517-323-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003058152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3046001Medicare PIN
MIDV1093Medicare PIN