MEDICARE: GREGORY A. ATKINS

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	4901002842	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376780825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY A. ATKINS

Provider Business Mailing Address
First Line	:	1266 SAND BEACH RD
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-8817
Country	:	US
Telephone Number	:	989-269-5393
Fax Number	:	989-269-6013

Provider Business Practice Location Address
First Line	:	1266 SAND BEACH RD
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-8817
Country	:	US
Telephone Number	:	989-269-5393
Fax Number	:	989-269-6013

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. REBECCA J. ATKINS
Credential	:
Telephone Number	:	989-269-5393

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/20/2009

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