Provider Demographics
NPI:1487755898
Name:ADAMS, DANIEL LEE (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:ADAMS
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 1:2123 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4136
Mailing Address - Country:US
Mailing Address - Phone:405-372-3724
Mailing Address - Fax:405-743-1042
Practice Address - Street 1:2123 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4136
Practice Address - Country:US
Practice Address - Phone:405-372-3724
Practice Address - Fax:405-743-1042
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761460AMedicaid
OK0268440001OtherPALMETTO GOVERNMENT BENEFIT ADMINISTRATORS
OK0268440001Medicare NSC
OK100761460AMedicaid