Healthcare Provider Details

I. General information

NPI: 1871761049
Provider Name (Legal Business Name): JEFFERY W ADKINS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 LAUREL HILLS DR
SACRAMENTO CA
95841-3106
US

IV. Provider business mailing address

5404 LAUREL HILLS DR
SACRAMENTO CA
95841-3106
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-4339
  • Fax: 916-537-2974
Mailing address:
  • Phone: 916-967-4339
  • Fax: 916-537-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 11060 TPA
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 15375 TLG
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA75077
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberA705770
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFERY W ADKINS
Title or Position: OWNER
Credential: MD
Phone: 916-967-4339