Organization
ROBERT D & CINDY L DOUGLAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY LEE DOUGLAS (OPTICIAN)
(231) 853-6459
Entity
Organization
Contact information
Practice address
12412 STAFFORD, RAVENNA, MI 49451-0307
(231) 853-6459
(231) 853-6459
Mailing address
12412 STAFFORD RD, RAVENNA, MI 49451-9783
(231) 853-6459
(231) 853-6459
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56038
DAVIS VISION
MI
01
—
900F176110
BLUE CROSS BLUESHIELD
MI
01
—
OP0965
EYE MED
MI
Enumeration date
02/26/2008
Last updated
09/23/2008
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