Provider Demographics
NPI:1760479182
Name:ADAMS, GERALD S (OD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:S
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 1:105 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-1305
Mailing Address - Country:US
Mailing Address - Phone:608-634-3434
Mailing Address - Fax:608-634-2024
Practice Address - Street 1:105 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667-1305
Practice Address - Country:US
Practice Address - Phone:608-634-3434
Practice Address - Fax:608-634-2024
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist