Provider Demographics
NPI:1942328232
Name:ATKINS, GREGORY A (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:ATKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-0249
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:989-269-7958
Practice Address - Fax:989-269-6013
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C26507OtherMEDICARE SUPPLIER #
MI5098386Medicaid
MI01633001Medicare PIN
MI5098386Medicaid