Healthcare Provider Details

I. General information

NPI: 1851519318
Provider Name (Legal Business Name): KENNETH PAUL ADAMS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7593 W BOYNTON BEACH BLVD
BOYNTON BEACH FL
33437-6154
US

IV. Provider business mailing address

12412 PRISTINE COURT NORTHEAST
ALBUQUERQUE NM
87122-4315
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-2740
  • Fax: 954-212-0494
Mailing address:
  • Phone: 505-242-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberOS19414
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberT7469
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberDR.0054870
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA-1439-08
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: