Provider Demographics
NPI:1043545122
Name:ADELMAN, SAMUEL EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EDWARD
Last Name:ADELMAN
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:PO BOX 86221
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97286-0221
Mailing Address - Country:US
Mailing Address - Phone:971-263-0495
Mailing Address - Fax:503-654-5429
Practice Address - Street 1:11800 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7711
Practice Address - Country:US
Practice Address - Phone:503-660-3093
Practice Address - Fax:503-654-5429
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3462ATI152W00000X
WAOD 60290877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist