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General NPI Number Information
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NPI Number | 1790762524
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Entity Type | Individual
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Provider Name | ALAN PAUL ADAMSON O.D
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 09/06/2023
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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 | 208-522-6120
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Provider Business Mailing Address
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Address Line | 3063 OLD CASTLE LN
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7352
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Country | US
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Telephone | 208-522-3237
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Fax |
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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 | ODP-1028
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 359678-9934
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License Number State | UT
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