Provider Demographics
NPI:1043268022
Name:HEROLD, ADAM (OD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:HEROLD
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 1:5000 BAKERS MILL LN STE 170
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2432
Mailing Address - Country:US
Mailing Address - Phone:804-359-0770
Mailing Address - Fax:804-359-1106
Practice Address - Street 1:5000 BAKERS MILL LN STE 170
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2432
Practice Address - Country:US
Practice Address - Phone:804-359-0770
Practice Address - Fax:804-359-1106
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010063698Medicaid
VA00V844L88Medicare ID - Type Unspecified