Provider Demographics
NPI:1770622284
Name:ATKINS, BRIAN DOUGLAS (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOUGLAS
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 1:2765 S VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6402
Mailing Address - Country:US
Mailing Address - Phone:217-787-6276
Mailing Address - Fax:217-787-6245
Practice Address - Street 1:2765 S VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6402
Practice Address - Country:US
Practice Address - Phone:217-787-6276
Practice Address - Fax:217-787-6245
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-8506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL369750Medicare ID - Type Unspecified
ILU56905Medicare UPIN