Provider Demographics
NPI:1124203542
Name:CHARLES S ADAMS OD APC
Entity Type:Organization
Organization Name:CHARLES S ADAMS OD APC
Other - Org Name:ADAMS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-742-4012
Mailing Address - Street 1:1911 BENTON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3500
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:SUITE C
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3500
Practice Address - Country:US
Practice Address - Phone:318-742-4012
Practice Address - Fax:318-742-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CC96Medicare PIN
LA4854310001Medicare NSC