Healthcare Provider Details

I. General information

NPI: 1396752671
Provider Name (Legal Business Name): WILLIAM R ATKINSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N. HUNTINGTON DRIVE UNIT A
ALGONQUIN IL
60102-5940
US

IV. Provider business mailing address

2100 N. HUNTINGTON DRIVE UNIT A
ALGANQUIN IL
60102-5940
US

V. Phone/Fax

Practice location:
  • Phone: 815-338-0107
  • Fax: 815-338-5104
Mailing address:
  • Phone: 317-254-6480
  • Fax: 317-259-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-008508
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: