Provider Demographics
NPI:1851344667
Name:ADAMS, BART A (MD)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SOUTHGATE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3953
Mailing Address - Country:US
Mailing Address - Phone:541-276-4752
Mailing Address - Fax:541-278-2918
Practice Address - Street 1:1050 SOUTHGATE
Practice Address - Street 2:SUITE A
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3953
Practice Address - Country:US
Practice Address - Phone:541-276-4752
Practice Address - Fax:541-278-2918
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30047207W00000X
CAG65424207W00000X
ORMD18666207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061275Medicaid
E25055Medicare UPIN
0000WCWBFMedicare ID - Type Unspecified