Provider Demographics
NPI:1376780825
Name:GREGORY A. ATKINS
Entity Type:Organization
Organization Name:GREGORY A. ATKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-269-5393
Mailing Address - Street 1:1266 SAND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-8817
Mailing Address - Country:US
Mailing Address - Phone:989-269-5393
Mailing Address - Fax:989-269-6013
Practice Address - Street 1:1266 SAND BEACH RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-8817
Practice Address - Country:US
Practice Address - Phone:989-269-5393
Practice Address - Fax:989-269-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942328232Medicaid
MI1942328232Medicaid
MI0C26507Medicare PIN
MI0163300001Medicare NSC