Provider Demographics
NPI:1184790842
Name:ADAMS, STUART (OD PC)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:OD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5220
Mailing Address - Country:US
Mailing Address - Phone:928-669-2497
Mailing Address - Fax:928-669-8424
Practice Address - Street 1:115 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5220
Practice Address - Country:US
Practice Address - Phone:928-669-2497
Practice Address - Fax:928-669-8424
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0179000OtherBCBS
AZ103713OtherAHCCCS
AZZWDBNJMedicare PIN
AZ410031734Medicare PIN
AZZ27220Medicare PIN
DR0109Medicare PIN
AZ0887700002Medicare NSC
AZU11054Medicare UPIN
AZ0410016906Medicare PIN
AZ103713OtherAHCCCS