Provider Demographics
NPI:1154567790
Name:SHUPE, ADAM T (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:T
Last Name:SHUPE
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Gender:M
Credentials:OD
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Mailing Address - Street 1:320 H ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5834
Mailing Address - Country:US
Mailing Address - Phone:530-743-1873
Mailing Address - Fax:530-743-1460
Practice Address - Street 1:320 H ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5834
Practice Address - Country:US
Practice Address - Phone:530-743-1873
Practice Address - Fax:530-743-1460
Is Sole Proprietor?:No
Enumeration Date:2009-01-04
Last Update Date:2013-07-30
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Provider Licenses
StateLicense IDTaxonomies
CA13737TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist