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General NPI Number Information
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NPI Number | 1780847442
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Entity Type | Organization
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Legal Business Name | ALAN ADAMSON, OD, PC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 2300 E 17TH ST SUITE 1157
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6504
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Country | US
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Telephone | 208-552-3355
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Fax | 208-552-6120
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Provider Business Mailing Address
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Address Line | PO BOX 3187
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3187
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Country | US
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Telephone | 208-552-3355
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Fax | 208-552-6120
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Authorized Official
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Title or Position | CEO
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Name | DR. ALAN P ADAMSON
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Credential | O.D.
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Telephone | 208-552-3355
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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-1028
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License Number State | ID
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