Provider Demographics
NPI:1669563565
Name:TOTTEN, DOUGLAS LEON (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LEON
Last Name:TOTTEN
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 1:951 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4341
Mailing Address - Country:US
Mailing Address - Phone:231-780-4700
Mailing Address - Fax:231-780-4722
Practice Address - Street 1:951 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4341
Practice Address - Country:US
Practice Address - Phone:231-780-4700
Practice Address - Fax:231-780-4722
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003038152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4454960Medicaid
4298240001OtherDMERC
4298240001OtherDMERC
MI4454960Medicaid