Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4371 | MA |
NPI | 1316983174 |
---|---|
Provider Name | Dr. Michael Robert Adams |
First Address | Dedham, MA 02026-6806 |
Second Address | Dedham, MA 02026-6806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0325198 | (05) | MA |
U99303 | (02) | MA |