=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992714463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAMS EYECARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 10/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3310 W MAIN ST SUITE 180
-----------------------------------------------------
City | ST CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60175-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-377-7722
-----------------------------------------------------
Fax | 630-377-7755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10
-----------------------------------------------------
City | STREAMWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60107-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-377-7722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. CARLA DENISE ADAMS
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 630-377-7722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046008731
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------