Provider Demographics
NPI:1043240906
Name:ADAMS, CHARLES SAVAGE (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:SAVAGE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 BENTON RD
Mailing Address - Street 2:STE C
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:318-742-4012
Mailing Address - Fax:318-742-1692
Practice Address - Street 1:1911 BENTON RD
Practice Address - Street 2:STE C
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-742-4012
Practice Address - Fax:318-742-1692
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1113163T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1982024Medicaid
LA4B049CC96Medicare ID - Type Unspecified
LA1982024Medicaid