| Organization Name: | ROBERT D & CINDY L DOUGLAS |
| NPI Number: | 1023287836 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CINDY LEE DOUGLAS (OPTICIAN) |
| Mailing Address: | 12412 Stafford Ravenna |
| State: | MI US |
| Postal Code: | 494510307 |
| Phone Number: | 2318536459 |
| Fax Number: | 2318536459 |
| NPI Enumeration Date: | 02/26/2008 |
| NPI Last Update Date: | 09/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156F00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A broad category grouping different kinds of technologists and technicians. See individual definitions. |