Provider Demographics
NPI:1083766356
Name:ADAM C. DAYLEY, O.D., P.C.
Entity Type:Organization
Organization Name:ADAM C. DAYLEY, O.D., P.C.
Other - Org Name:EYE CLINIC OF OROFINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAYLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-476-3815
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-1269
Mailing Address - Country:US
Mailing Address - Phone:208-476-3815
Mailing Address - Fax:208-476-9764
Practice Address - Street 1:906 MICHIGAN AVE.
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544
Practice Address - Country:US
Practice Address - Phone:208-476-3815
Practice Address - Fax:208-476-3815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAM C. DAYLEY, O.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806634300Medicaid
ID1366640Medicare PIN
IDU95828Medicare UPIN
ID5824290001Medicare NSC
ID15941281Medicare PIN