Organization

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)

Code

156F00000X

Primary Taxonomy

Yes

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

Provider Address