Provider Demographics
NPI:1548381635
Name:A & M OPTICAL
Entity Type:Organization
Organization Name:A & M OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-338-0107
Mailing Address - Street 1:591 SOUTH EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4631
Mailing Address - Country:US
Mailing Address - Phone:815-338-0107
Mailing Address - Fax:815-338-5104
Practice Address - Street 1:591 SOUTH EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-4631
Practice Address - Country:US
Practice Address - Phone:815-338-0107
Practice Address - Fax:815-338-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05632271OtherBLUE CROSS BLUE SHIELD
1548381635OtherOFFICE NPI
IL207743Medicare PIN
05632271OtherBLUE CROSS BLUE SHIELD