MEDICARE: DR. DOUGLAS EDWARD ATKINSON OD PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002843	MI

General Provider Information

NPI Number	:	1003806696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS EDWARD ATKINSON OD PLC

Provider Business Mailing Address
First Line	:	9361 CHERRY VALLEY AVE SE
Second Line	:
City	:	CALEDONIA
State	:	MI
Zip	:	49316-9506
Country	:	US
Telephone Number	:	616-891-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	9361 CHERRY VALLEY AVE SE
Second Line	:
City	:	CALEDONIA
State	:	MI
Zip	:	49316-9506
Country	:	US
Telephone Number	:	616-891-4321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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