MEDICARE: FRANK THOMAS ADAM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV005737-1	NY

General Provider Information

NPI Number	:	1831219591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK THOMAS ADAM O.D.

Provider Business Mailing Address
First Line	:	500 PORTION RD
Second Line	:	SUITE 10
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-4587
Country	:	US
Telephone Number	:	631-648-9488
Fax Number	:	631-676-4861

Provider Business Practice Location Address
First Line	:	500 PORTION RD
Second Line	:	SUITE 10
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-4587
Country	:	US
Telephone Number	:	631-648-9488
Fax Number	:	631-676-4861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	02/28/2012

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