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General NPI Number Information
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NPI Number | 1417130543
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Entity Type | Organization
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Legal Business Name | JK OPTICAL, INC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 10550 S CICERO AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-5267
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Country | US
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Telephone | 708-499-3911
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Fax | 708-424-5318
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Provider Business Mailing Address
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Address Line | 10550 S CICERO AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-5267
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Country | US
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Telephone | 708-499-3911
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Fax | 708-424-5318
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Authorized Official
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Title or Position | OFFICER
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Name | DR. WALTER ATKENSON JR.
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Credential | O.D.
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Telephone | 708-499-3911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 46007528
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 46007528
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 46007555
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 46007555
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License Number State | IL
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