Provider Demographics
NPI:1720199409
Name:ADAMS, CARLA DENISE (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:DENISE
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-0010
Mailing Address - Country:US
Mailing Address - Phone:630-377-7722
Mailing Address - Fax:
Practice Address - Street 1:3310 W MAIN ST
Practice Address - Street 2:SUITE 180
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1000
Practice Address - Country:US
Practice Address - Phone:630-377-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL359391Medicare ID - Type Unspecified
ILU54453Medicare UPIN