Provider Demographics
NPI:1881961290
Name:KENNETH P. ADAMS, D.O.,P.C
Entity type:Organization
Organization Name:KENNETH P. ADAMS, D.O.,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLEOWNER/OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNTH
Authorized Official - Middle Name:P
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-822-1352
Mailing Address - Street 1:12412 PRISTINE COURT NORTHEAST
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-4315
Mailing Address - Country:US
Mailing Address - Phone:505-242-3330
Mailing Address - Fax:
Practice Address - Street 1:12412 PRISTINE COURT NORTHEAST
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-4315
Practice Address - Country:US
Practice Address - Phone:505-242-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1439-08207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty