Healthcare Provider Details

I. General information

NPI: 1881961290
Provider Name (Legal Business Name): KENNETH P. ADAMS, D.O.,P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12412 PRISTINE COURT NORTHEAST
ALBUQUERQUE NM
87122-4315
US

IV. Provider business mailing address

12412 PRISTINE COURT NORTHEAST
ALBUQUERQUE NM
87122-4315
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-3330
  • Fax:
Mailing address:
  • Phone: 505-242-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA-1439-08
License Number StateNM

VIII. Authorized Official

Name: DR. KENNTH P ADAMS
Title or Position: SOLEOWNER/OPHTHALMOLOGIST
Credential: D.O.
Phone: 505-822-1352