Provider Demographics
NPI:1821314154
Name:DR. JACK ADKINS & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DR. JACK ADKINS & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-323-3399
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3046Medicare PIN