Healthcare Provider Details

I. General information

NPI: 1275537961
Provider Name (Legal Business Name): ADAM DAVID MARK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 ROUTE 34
MATAWAN NJ
07747-3283
US

IV. Provider business mailing address

935 HWY 34 STE 1A
MATAWAN NJ
07747-3282
US

V. Phone/Fax

Practice location:
  • Phone: 732-583-9797
  • Fax: 732-583-3634
Mailing address:
  • Phone: 732-583-9797
  • Fax: 732-583-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00560700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: