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General NPI Number Information
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NPI Number | 1912166166
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Entity Type | Organization
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Legal Business Name | RK ATANASOFF OD PC
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 131 W GENESEE ST
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City | IRON RIVER
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State | MI
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Zip | 49935
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Country | US
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Telephone | 906-265-9931
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Fax | 906-265-6202
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Provider Business Mailing Address
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Address Line | 131 W GENESEE ST
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City | IRON RIVER
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State | MI
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Zip | 49935
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Country | US
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Telephone | 906-265-9931
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Fax | 906-265-6202
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RAYMOND KRIST ATANASOFF
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Credential | OD
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Telephone | 906-265-9931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2518
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License Number State | MI
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