Healthcare Provider Details

I. General information

NPI: 1760920250
Provider Name (Legal Business Name): JOHN ATKINSON, OD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
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 TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1271
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1271
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number1271
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number1271
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1271
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN ATKINSON
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 704-938-1135