Provider Demographics
NPI:1356544209
Name:FEDYK, ADAM ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ROSS
Last Name:FEDYK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1585 WOODLAKE DR.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TOWN & COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-326-4800
Mailing Address - Fax:314-266-0558
Practice Address - Street 1:1585 WOODLAKE DR.
Practice Address - Street 2:SUITE 106
Practice Address - City:TOWN & COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-326-4800
Practice Address - Fax:314-266-0558
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2022-12-29
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Provider Licenses
StateLicense IDTaxonomies
MO2008009796207W00000X, 207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO132590001Medicare UPIN
MO152360008Medicare UPIN