Healthcare Provider Details

I. General information

NPI: 1821367236
Provider Name (Legal Business Name): STUART ADAMS OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N SPRING ST
BLYTHE CA
92225-1633
US

IV. Provider business mailing address

110 N SPRING ST
BLYTHE CA
92225-1633
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-3951
  • Fax: 760-922-5202
Mailing address:
  • Phone: 760-922-3951
  • Fax: 760-922-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT9189
License Number StateCA

VIII. Authorized Official

Name: STUART B ADAMS
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 928-680-1144