Robert D & Cindy L Douglas
Technician/Technologist in Ravenna, MI(View on Map)
Legal Business Name
Robert D & Cindy L Douglas
NPI Number
1023287836
NPI Type
Organization
Enumeration Date
02/26/2008
Specialties
(Taxonomies)Contact
Information
Purpose
Mailing
Location
Address
12412 STAFFORD RD
12412 STAFFORD
City
Ravenna
Ravenna
State
MI
MI
Postal Code
49451-9783
49451-0307
Country
US
US
Telephone Number
(231) 853-6459
(231) 853-6459
Authorized Official
Name
Cindy Douglas
Title or Position
OPTICIAN
Telephone Number
(231) 853-6459
Identifiers
Identifier
56038
900F176110
OP0965
Identifier State
MI
MI
MI
Identifier Issuer
DAVIS VISION
BLUE CROSS BLUESHIELD
EYE MED
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 09/23/2008