Provider Demographics
NPI:1518993641
Name:ADAM H MADISON ODPC
Entity Type:Organization
Organization Name:ADAM H MADISON ODPC
Other - Org Name:EYE CARE DOCTORS OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-548-2345
Mailing Address - Street 1:1669 CARL D SILVER PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4934
Mailing Address - Country:US
Mailing Address - Phone:540-548-2345
Mailing Address - Fax:540-548-1222
Practice Address - Street 1:1669 CARL D SILVER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4934
Practice Address - Country:US
Practice Address - Phone:540-548-2345
Practice Address - Fax:540-548-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08770Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER