Provider Demographics
NPI:1548289929
Name:ATKINSON, ANN STURGIS (OD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:STURGIS
Last Name:ATKINSON
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 1:196 GROVE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:THOROFARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-2139
Mailing Address - Country:US
Mailing Address - Phone:856-848-3020
Mailing Address - Fax:856-845-7719
Practice Address - Street 1:196 GROVE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:THOROFARE
Practice Address - State:NJ
Practice Address - Zip Code:08086-2139
Practice Address - Country:US
Practice Address - Phone:856-848-3020
Practice Address - Fax:856-845-7719
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00514600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU54909Medicare UPIN
NJAT627426Medicare ID - Type Unspecified