Healthcare Provider Details

I. General information

NPI: 1023203643
Provider Name (Legal Business Name): ADAMS EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S MAIN ST
WESTBY WI
54667-1305
US

IV. Provider business mailing address

105 S MAIN ST
WESTBY WI
54667-1305
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-3434
  • Fax: 608-634-2024
Mailing address:
  • Phone: 608-634-3434
  • Fax: 608-634-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2405
License Number StateWI

VIII. Authorized Official

Name: DR. GERALD S ADAMS
Title or Position: DOCTOR OF OPTOMETRY
Credential: OD
Phone: 608-634-3434