Provider Demographics
NPI:1669534830
Name:ADAMS, TERRY L (OD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1517
Mailing Address - Country:US
Mailing Address - Phone:307-532-2060
Mailing Address - Fax:307-532-5710
Practice Address - Street 1:520 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1517
Practice Address - Country:US
Practice Address - Phone:307-532-2060
Practice Address - Fax:307-532-5710
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY123T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY410016780OtherRR MEDICARE PROVIDER NUMB
WY103452900Medicaid
WY310522OtherBCBS PROVIDER NUMBER
WYW305339Medicare PIN
WY0312350002Medicare NSC
WYT40295Medicare UPIN
WY310522OtherBCBS PROVIDER NUMBER