Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901002843 | MI |
NPI | 1003806696 |
---|---|
Provider Name | Dr. Douglas Edward Atkinson |
First Address | Caledonia, MI 49316-9506 |
Second Address | Caledonia, MI 49316-9506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T33056 | (02) | MI |