Provider Demographics
NPI:1376551788
Name:ATANASOFF, RAYMOND KRIST (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:KRIST
Last Name:ATANASOFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:R
Other - Middle Name:K
Other - Last Name:ATANASOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:131 W GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935
Mailing Address - Country:US
Mailing Address - Phone:906-265-9931
Mailing Address - Fax:906-265-6202
Practice Address - Street 1:131 W GENESEE STREET
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935
Practice Address - Country:US
Practice Address - Phone:906-265-9931
Practice Address - Fax:906-265-6202
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2518152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI580002464OtherRAILROAD MEDICARE
MI900C664040OtherBCBS
MI945047510Medicaid
MI0776580001OtherADIMASTER
MI945047510Medicaid
MI900C664040OtherBCBS