Provider Demographics
NPI:1497826986
Name:ADAMS, WILLIAM JEPTHA (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JEPTHA
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:PO BOX 1916
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-1916
Mailing Address - Country:US
Mailing Address - Phone:252-441-4872
Mailing Address - Fax:252-441-7812
Practice Address - Street 1:1004 S. CROATAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948
Practice Address - Country:US
Practice Address - Phone:252-441-4872
Practice Address - Fax:252-441-7812
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09011OtherBLUE CROSSBLUESHIELD
NC246552Medicare ID - Type Unspecified
NCT65113Medicare UPIN