Provider Demographics
NPI:1851969836
Name:AUTUMN ADAMS OD PLLC
Entity Type:Organization
Organization Name:AUTUMN ADAMS OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-941-4321
Mailing Address - Street 1:4101 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7418
Mailing Address - Country:US
Mailing Address - Phone:501-941-4321
Mailing Address - Fax:501-508-8494
Practice Address - Street 1:4101 S 1ST ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7418
Practice Address - Country:US
Practice Address - Phone:501-941-4321
Practice Address - Fax:501-508-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty