Provider Demographics
NPI:1942352380
Name:ADAM C. DAYLEY, O.D., P.C.
Entity Type:Organization
Organization Name:ADAM C. DAYLEY, O.D., P.C.
Other - Org Name:LOOKING GLASS EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAYLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-935-2020
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:KAMIAH
Mailing Address - State:ID
Mailing Address - Zip Code:83536-0247
Mailing Address - Country:US
Mailing Address - Phone:208-935-2020
Mailing Address - Fax:208-935-0434
Practice Address - Street 1:501 MAIN ST.
Practice Address - Street 2:
Practice Address - City:KAMIAH
Practice Address - State:ID
Practice Address - Zip Code:83536
Practice Address - Country:US
Practice Address - Phone:208-935-2020
Practice Address - Fax:208-935-0434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAM C. DAYLEY, O.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807089100Medicaid
ID807089100Medicaid
ID5824290002Medicare NSC
IDU925828Medicare UPIN
ID15941282Medicare PIN