Provider Demographics
NPI:1982630570
Name:ADAMS, THOMAS L (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2205 VESPER CIRCLE
Mailing Address - Street 2:STE 104
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3501
Mailing Address - Country:US
Mailing Address - Phone:951-520-1212
Mailing Address - Fax:951-520-1297
Practice Address - Street 1:2205 VESPER CIRCLE
Practice Address - Street 2:STE 104
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3501
Practice Address - Country:US
Practice Address - Phone:951-520-1212
Practice Address - Fax:951-520-1297
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6154T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061540Medicaid
T10246Medicare UPIN