Provider Demographics
NPI:1538144928
Name:DAYLEY, ADAM C (OD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:DAYLEY
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 129
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-0129
Mailing Address - Country:US
Mailing Address - Phone:208-476-3815
Mailing Address - Fax:
Practice Address - Street 1:906 MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544
Practice Address - Country:US
Practice Address - Phone:208-476-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP100032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806634300Medicaid
ID806634300Medicaid
ID5824290001Medicare NSC
ID1594129Medicare ID - Type Unspecified