Provider Demographics
NPI:1396827663
Name:ADAMS, KENT E (OD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:E
Last Name:ADAMS
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 1:4412 MATLOCK RD
Mailing Address - Street 2:400
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5259
Mailing Address - Country:US
Mailing Address - Phone:817-468-1188
Mailing Address - Fax:817-468-1460
Practice Address - Street 1:4412 MATLOCK RD
Practice Address - Street 2:400
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5259
Practice Address - Country:US
Practice Address - Phone:817-468-1188
Practice Address - Fax:817-468-1460
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2322TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT 11880Medicare UPIN