Healthcare Provider Details

I. General information

NPI: 1942294038
Provider Name (Legal Business Name): ADAM Z AHMADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W ELM AVE STE 170
HERMISTON OR
97838-2715
US

IV. Provider business mailing address

1050 W ELM AVE STE 170
HERMISTON OR
97838-2715
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3882
  • Fax: 485-219-3120
Mailing address:
  • Phone: 541-667-3882
  • Fax: 458-219-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD227570
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA89874
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2005-0295
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: