Provider Demographics
NPI:1447328497
Name:STUART ADAMS O.D. PC
Entity type:Organization
Organization Name:STUART ADAMS O.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:ODPC
Authorized Official - Phone:928-680-1144
Mailing Address - Street 1:383 LAKE HAVASU AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-9368
Mailing Address - Country:US
Mailing Address - Phone:928-680-1144
Mailing Address - Fax:928-680-8639
Practice Address - Street 1:383 S.LAKE HAVASU AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-9368
Practice Address - Country:US
Practice Address - Phone:928-680-1144
Practice Address - Fax:928-680-8639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103713OtherAHCCCS
AZAZ0179000OtherBCBS
AZAZ0179000OtherBCBS
AZU11054Medicare UPIN
DR0109Medicare PIN
AZ0887700002Medicare NSC
AZ103713OtherAHCCCS
AZ410016906Medicare PIN