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General NPI Number Information
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NPI Number | 1194861310
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Entity Type | Individual
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Provider Name | DANIEL JACK ADAMS OD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 1813 S VAN DYKE
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City | IMLAY CITY
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State | MI
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Zip | 48444
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Country | US
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Telephone | 989-721-9411
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Fax | 989-721-9512
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Provider Business Mailing Address
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Address Line | 140 MACOMB
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City | MT CLEMENS
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State | MI
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Zip | 48043
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Country | US
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Telephone | 586-468-7370
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Fax | 586-464-1472
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4901003230
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License Number State | MI
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