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General NPI Number Information
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NPI Number | 1063759199
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Entity Type | Organization
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Legal Business Name | ADAMS EYECARE INC
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 3541 W BAVARIA ST
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City | EAGLE
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State | ID
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Zip | 83616-6318
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Country | US
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Telephone | 208-939-5005
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Fax | 208-939-2496
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Provider Business Mailing Address
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Address Line | 3541 W BAVARIA ST
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City | EAGLE
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State | ID
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Zip | 83616-6318
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Country | US
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Telephone | 208-939-5005
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Fax | 208-939-2496
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADAM HEINER
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Credential | OD
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Telephone | 208-283-8815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-1041
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License Number State | ID
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