Provider Demographics
NPI:1831219591
Name:ADAM, FRANK THOMAS (OD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:THOMAS
Last Name:ADAM
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 1:500 PORTION RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4587
Mailing Address - Country:US
Mailing Address - Phone:631-648-9488
Mailing Address - Fax:631-676-4861
Practice Address - Street 1:500 PORTION RD
Practice Address - Street 2:SUITE 10
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4587
Practice Address - Country:US
Practice Address - Phone:631-648-9488
Practice Address - Fax:631-676-4861
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005737-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300059769Medicare PIN