Provider Demographics
NPI:1932290764
Name:ADAM, BRIAN L (OD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:ADAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 O STREET
Mailing Address - Street 2:#127
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2460
Mailing Address - Country:US
Mailing Address - Phone:402-466-4111
Mailing Address - Fax:402-466-4202
Practice Address - Street 1:6900 O STREET
Practice Address - Street 2:#127
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2460
Practice Address - Country:US
Practice Address - Phone:402-466-4111
Practice Address - Fax:402-466-4202
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025846400Medicaid
NE10025174100Medicaid
NE6372880001Medicare NSC
V02275Medicare UPIN
099606Medicare ID - Type Unspecified
NENA1488001Medicare PIN
NE1279750001Medicare NSC