MEDICARE: STUART ADAMS O.D. PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103713	OTHER	AZ	AHCCCS
2	AZ0179000	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1447328497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUART ADAMS O.D. PC

Provider Business Mailing Address
First Line	:	383 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9368
Country	:	US
Telephone Number	:	928-680-1144
Fax Number	:	928-680-8639

Provider Business Practice Location Address
First Line	:	383 S.LAKE HAVASU AVE
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9368
Country	:	US
Telephone Number	:	928-680-1144
Fax Number	:	928-680-8639

Authorized Official
Title or Position	:	OWNER
Name	:	STUART ADAMS
Credential	:	O.D.PC
Telephone Number	:	928-680-1144

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	11/07/2012

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