Conrad Faulkner OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

0758 Issued in NC

Legal business name

CONRAD FAULKNER OD PA

Practice address

834 Hardee Rd
Vernon Park Mall
Kinston, NC 28504-3360

Phone

(252) 559-2020

NPI assigned

Jul 29, 2009

Organization subpart

No

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

Authorized official

Name

James C Faulkner

Title

Optometrist

Phone

(252) 566-4583

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248825600000",
    "number": "1750512414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7395 US HIGHWAY 70 W",
            "city": "LA GRANGE",
            "state": "NC",
            "postal_code": "285518211",
            "telephone_number": "252-566-4583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 HARDEE RD",
            "address_2": "VERNON PARK MALL",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285043360",
            "telephone_number": "252-559-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONRAD FAULKNER OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-29",
        "last_updated": "2009-07-29",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "252-566-4583"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "0758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "09271",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID- TYPE UNSPECIFIED",
            "identifier": "246158",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Kinston, NC
• Providers in Kinston, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.