Provider Demographics
NPI:1063759199
Name:ADAMS EYECARE INC
Entity type:Organization
Organization Name:ADAMS EYECARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-283-8815
Mailing Address - Street 1:3541 W BAVARIA ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6318
Mailing Address - Country:US
Mailing Address - Phone:208-939-5005
Mailing Address - Fax:208-939-2496
Practice Address - Street 1:3541 W BAVARIA ST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6318
Practice Address - Country:US
Practice Address - Phone:208-939-5005
Practice Address - Fax:208-939-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1992792469Medicaid