Provider Demographics
NPI:1205943727
Name:ATKINSON, TIMOTHY HAROLD (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:HAROLD
Last Name:ATKINSON
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 1:301 N BALL ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-723-3094
Mailing Address - Fax:989-725-0130
Practice Address - Street 1:301 N BALL ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-3094
Practice Address - Fax:989-725-0130
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG865040OtherBCBS
MI0778130001OtherAMERISTAR
MIT33607Medicare UPIN
MIG865040OtherBCBS