Healthcare Provider Details

I. General information

NPI: 1396014486
Provider Name (Legal Business Name): ADAM JOSEPH PALO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SEABOARD STATION DR
RALEIGH NC
27604-1199
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 919-200-4840
  • Fax: 919-977-6943
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2243
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: