# ROBERT D & CINDY L DOUGLAS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023287836
- **Authorized official:** CINDY LEE DOUGLAS (OPTICIAN)
- **Authorized official phone:** (231) 853-6459

## Contact information

- **Practice address:** 12412 STAFFORD, RAVENNA, MI 49451-0307
- **Practice address phone:** (231) 853-6459
- **Practice address fax:** (231) 853-6459
- **Mailing address:** 12412 STAFFORD RD, RAVENNA, MI 49451-9783
- **Mailing address phone:** (231) 853-6459
- **Mailing address fax:** (231) 853-6459

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156F00000X | Technician/Technologist | — | — | Yes |

## Other

- **Enumeration date:** 02/26/2008
- **Last updated:** 09/23/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 56038 | DAVIS VISION | MI |
| 01 | — | 900F176110 | BLUE CROSS BLUESHIELD | MI |
| 01 | — | OP0965 | EYE MED | MI |