Individual
DR. GEORGE M. CONEKIN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
200 DOCTORS DR, SUITE K, JACKSONVILLE, NC 28546-6308
(910) 353-0541
(910) 353-5353
Mailing address
200 DOCTORS DR, SUITE K, JACKSONVILLE, NC 28546-6308
(910) 353-0541
(910) 353-5353
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1181
NC
152WC0802X
Corneal and Contact Management Optometrist
1181
NC
152WL0500X
Low Vision Rehabilitation Optometrist
1181
NC
152WP0200X
Pediatric Optometrist
1181
NC
152WS0006X
Sports Vision Optometrist
1181
NC
152WV0400X
Vision Therapy Optometrist
1181
NC
152WX0102X
Occupational Vision Optometrist
1181
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09328
BCBS ID#
NC
01
—
170000072
RAILROAD MEDICARE ID#
NC
01
—
561719600
TRICARE/HEALTH NET ID#
NC
05
—
7909328
—
NC
01
—
Y1605
BLIND COMMISSION ID#
NC
Enumeration date
05/02/2006
Last updated
12/12/2008
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