Provider Demographics
NPI:1922058056
Name:ATKINS, STACIE L (OD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:L
Last Name:ATKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NW JOHN JONES DR
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5948T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU99629Medicare ID - Type UnspecifiedMEDICARE