Provider Demographics
NPI:1912166166
Name:RK ATANASOFF OD PC
Entity Type:Organization
Organization Name:RK ATANASOFF OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:KRIST
Authorized Official - Last Name:ATANASOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-265-9931
Mailing Address - Street 1:131 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935
Mailing Address - Country:US
Mailing Address - Phone:906-265-9931
Mailing Address - Fax:906-265-6202
Practice Address - Street 1:131 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935
Practice Address - Country:US
Practice Address - Phone:906-265-9931
Practice Address - Fax:906-265-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2518152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900C665040OtherBLUE CROSS AND BLUE SHIELD
MI945047510Medicaid
MIOC66504Medicare UPIN
MIT32915Medicare PIN
MI580002464Medicare UPIN
MI0776580001Medicare NSC