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ROBERT DEAN DOUGLAS

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1861516239

Individual Registrant:
 ROBERT DEAN DOUGLAS 
Gender: M
Sole Proprietor

Location and contact information for practice:
12412 STAFFORD ST  RAVENNA, MI 48451-0307 US
Tel: 231-853-6459  Fax: 231-853-6459

Contact information for business:
PO BOX 307 12412 STAFFORD ST RAVENNA, MI 49451-0307 US
Tel: 231-853-6459  Fax: 231-853-6459

Registration Information:
NPI: 1861516239
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
MIMI3937

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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