Provider Demographics
NPI:1083614911
Name:ADAMCZAK, THOMAS MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:ADAMCZAK
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 1:105 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2024
Mailing Address - Country:US
Mailing Address - Phone:616-846-0620
Mailing Address - Fax:616-844-6079
Practice Address - Street 1:1315 E COLBY ST
Practice Address - Street 2:SUITE A
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1283
Practice Address - Country:US
Practice Address - Phone:231-894-9300
Practice Address - Fax:231-894-9301
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI203050498OtherTAX ID
MI383628290OtherTAX ID
MI900F210170OtherBCBS OF MICHIGAN
MI900F111560OtherBCBS OF MICHIGAN
MI5375940004Medicare NSC
MI5548200002Medicare NSC
MIDD1664Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
MIP00211876Medicare ID - Type UnspecifiedRAILROAD INDIVIDUAL
MI203050498OtherTAX ID
MIU59119Medicare UPIN
MI0P25500Medicare ID - Type UnspecifiedMI MEDICARE GROUP
MI5548200001Medicare NSC
MIP13290001Medicare PIN
MIP25500002Medicare ID - Type UnspecifiedMI MEDICARE INDIVIDUAL