Provider Demographics
NPI:1780847442
Name:ALAN ADAMSON, OD, PC
Entity Type:Organization
Organization Name:ALAN ADAMSON, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-552-3355
Mailing Address - Street 1:PO BOX 3187
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-3187
Mailing Address - Country:US
Mailing Address - Phone:208-552-3355
Mailing Address - Fax:208-552-6120
Practice Address - Street 1:2300 E 17TH ST
Practice Address - Street 2:SUITE 1157
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6504
Practice Address - Country:US
Practice Address - Phone:208-552-3355
Practice Address - Fax:208-552-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807677100Medicaid
ID000010144405OtherREGENCE BLUESHIELD
IDV4650OtherBLUE CROSS OF IDAHO
ID807677100Medicaid
ID000010144405OtherREGENCE BLUESHIELD