Provider Demographics
NPI:1396752671
Name:ATKINSON, WILLIAM R (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2100 N. HUNTINGTON DRIVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:ALGANQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5940
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:2100 N. HUNTINGTON DRIVE
Practice Address - Street 2:UNIT A
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5940
Practice Address - Country:US
Practice Address - Phone:815-338-0107
Practice Address - Fax:815-338-5104
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU57904Medicare UPIN
IL0749230001Medicare NSC
IL375830Medicare PIN