Healthcare Provider Details

I. General information

NPI: 1588899744
Provider Name (Legal Business Name): JOHN ERIC ATKINSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 JACKSON PARK RD
KANNAPOLIS NC
28083-3660
US

IV. Provider business mailing address

608 JACKSON PARK RD
KANNAPOLIS NC
28083-3660
US

V. Phone/Fax

Practice location:
  • Phone: 704-938-1135
  • Fax: 704-938-1200
Mailing address:
  • Phone: 704-938-1135
  • Fax: 704-938-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ERIC ATKINSON
Title or Position: OWNER
Credential: OD
Phone: 704-938-1135