Provider Demographics
NPI:1790762524
Name:ADAMSON, ALAN PAUL (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:PAUL
Last Name:ADAMSON
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 1:3063 OLD CASTLE LN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7352
Mailing Address - Country:US
Mailing Address - Phone:208-522-3237
Mailing Address - Fax:
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:208-522-6120
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1028152W00000X
UT359678-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU82454Medicare UPIN
ID1593528Medicare ID - Type UnspecifiedMEDICARE