Healthcare Provider Details

I. General information

NPI: 1851344667
Provider Name (Legal Business Name): BART A ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SOUTHGATE SUITE A
PENDLETON OR
97801-3953
US

IV. Provider business mailing address

1050 SOUTHGATE SUITE A
PENDLETON OR
97801-3953
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-4752
  • Fax: 541-278-2918
Mailing address:
  • Phone: 541-276-4752
  • Fax: 541-278-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number30047
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG65424
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD18666
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: