Provider Demographics
NPI:1437220712
Name:ADAMS, RENEE DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:DAWN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-1913
Mailing Address - Country:US
Mailing Address - Phone:618-943-6400
Mailing Address - Fax:618-943-6404
Practice Address - Street 1:1703 STATE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-1913
Practice Address - Country:US
Practice Address - Phone:618-943-6400
Practice Address - Fax:618-943-6404
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILVO7581Medicare UPIN
ILK23166Medicare ID - Type Unspecified
IL6347990001Medicare NSC