Provider Demographics
NPI:1235144650
Name:MONTE VON ADAMS
Entity Type:Organization
Organization Name:MONTE VON ADAMS
Other - Org Name:ADAMS OPTICAL FASHIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:VON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-228-1012
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-0009
Mailing Address - Country:US
Mailing Address - Phone:402-228-1012
Mailing Address - Fax:402-228-1012
Practice Address - Street 1:512 BELL ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-4445
Practice Address - Country:US
Practice Address - Phone:402-228-1012
Practice Address - Fax:402-228-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid