Individual provider Active NPI

Kevin Darnell Anthony Atkinson, OD

  • Optometrist
  • Jackson Heights, NY
National Provider Identifier
1215751961
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
011107 Issued in NY
Practice address
9016 Elmhurst Ave
Jackson Heights, NY 11372-7936
Phone
(718) 651-2200
NPI assigned
Nov 11, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 011107 NY Primary

Addresses

Primary practice location

9016 Elmhurst Ave
Jackson Heights, NY 11372-7936

Mailing address

9016 Elmhurst Ave
Jackson Heights, NY 11372-7936
Phone (718) 651-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241213003000 NY Practitioner - Optometry 0446786438

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1046 Cramer CT
North Baldwin, NY 11510-1218

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011107NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sajid Malik MD PC Optometrist CurrentSince Nov 26, 2024 Accepting new patients
Woodbury Optical Studio, Inc. Past Accepting new patients

Locations

185 Woodbury Rd
Hicksville, NY 11801
Phone (516) 681-3937

9016 Elmhurst Ave
Jackson Heights, NY 11372
Phone (718) 499-4260

9014 Elmhurst Ave
Jackson Hts, NY 11372
Phone (718) 651-2200

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1215751961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9016 ELMHURST AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727936",
            "telephone_number": "718-651-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9016 ELMHURST AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727936",
            "telephone_number": "718-651-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATKINSON",
        "first_name": "KEVIN DARNELL",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "011107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.