Provider Demographics
NPI:1871761049
Name:JEFFERY W ADKINS MD
Entity type:Organization
Organization Name:JEFFERY W ADKINS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-967-4339
Mailing Address - Street 1:5404 LAUREL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3106
Mailing Address - Country:US
Mailing Address - Phone:916-967-4339
Mailing Address - Fax:916-537-2974
Practice Address - Street 1:5404 LAUREL HILLS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3106
Practice Address - Country:US
Practice Address - Phone:916-967-4339
Practice Address - Fax:916-537-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11060 TPA152W00000X
CAOPT 15375 TLG152W00000X
CAA75077207W00000X
CAA705770332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4871020001Medicare NSC