Provider Demographics
NPI:1336137397
Name:ADAMS, JAMES ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 NEWPORT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-9233
Mailing Address - Country:US
Mailing Address - Phone:269-382-6500
Mailing Address - Fax:269-382-2286
Practice Address - Street 1:6101 NEWPORT RD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-9233
Practice Address - Country:US
Practice Address - Phone:269-382-6500
Practice Address - Fax:269-382-2286
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381734365OtherTAX ID
MI17800OtherSPECTERA
MI900C947460OtherBCBS
MI5031190Medicaid
MI4901002440OtherLICENSE
MI2230411OtherUHC,IBA,PHP
MI381734365OtherTAX ID
0311680001Medicare NSC
C94746002Medicare PIN