Daniel Jack Adams, OD
Individual provider Active NPI Optometrist · Imlay City, MI
NPI 1194861310 · NPPES record last updated Jul 28, 2009
Key facts
- NPI
- 1194861310
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901003230 (MI)
- Practice address
- 1813 S Van Dyke
Imlay City, MI 48444 - Phone
- (989) 721-9411
- Fax
- (989) 721-9512
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901003230 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SVS Vision Inc | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003230 | MI | Yes |
Addresses
Primary practice location
1813 S Van Dyke
Imlay City, MI 48444
Mailing address
140 Macomb
Mt Clemens, MI 48043
Phone (586) 468-7370
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 944498982 | Medicaid | MI |
Other providers in Imlay City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.