Basic Information
| Provider Information | |||||||||
| NPI: | 1821367236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STUART ADAMS OD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N SPRING ST | ||||||||
| Address2: | |||||||||
| City: | BLYTHE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922251633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609223951 | ||||||||
| FaxNumber: | 7609225202 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 N SPRING ST | ||||||||
| Address2: | |||||||||
| City: | BLYTHE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922251633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609223951 | ||||||||
| FaxNumber: | 7609225202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 05/31/2012 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9286801144 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT9189 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.