Provider Demographics
NPI:1316983174
Name:ADAMS, MICHAEL ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
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 1:870 PROVIDENCE HWY
Mailing Address - Street 2:ATTN: DR. ADAMS
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6806
Mailing Address - Country:US
Mailing Address - Phone:781-329-0067
Mailing Address - Fax:781-320-5603
Practice Address - Street 1:870 PROVIDENCE HWY
Practice Address - Street 2:ATTN: DR. ADAMS
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6806
Practice Address - Country:US
Practice Address - Phone:781-329-0067
Practice Address - Fax:781-320-5603
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4371152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0325198Medicaid
MAW17526Medicare ID - Type Unspecified
MAU99303Medicare UPIN