Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1184783227 |
---|---|
Provider Name | Patrick Adkins |
First Address | Des Plaines, IL 60016-5316 |
Second Address | Des Plaines, IL 60016-5316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001670211 | BLUE CROSS BLUE SHIELD (01) | IL |
753100 | ADVOCATE HEALTHCARE (01) | IL |