Provider Demographics
NPI:1396238689
Name:ADAMS, DANIEL LEO (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEO
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1975
Mailing Address - Country:US
Mailing Address - Phone:208-772-5539
Mailing Address - Fax:208-485-7444
Practice Address - Street 1:8220 N CORNERSTONE DR STE A
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8683
Practice Address - Country:US
Practice Address - Phone:208-772-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist