Adam Larry Maddocks, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

10295884-9934 Issued in UT

Practice address

1150 S 100 W
Logan, UT 84321-5573

Phone

(435) 754-3459

Fax

(435) 787-8498

NPI assigned

Sep 29, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1922478239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 S 100 W",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215573",
            "telephone_number": "435-754-3459",
            "fax_number": "435-787-8498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 S 100 W",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215573",
            "telephone_number": "435-754-3459",
            "fax_number": "435-787-8498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDOCKS",
        "first_name": "ADAM",
        "middle_name": "LARRY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-29",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "10295884-9934",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004935",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH DEPARTMENT OF COMMERCE, DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING",
            "identifier": "10295884-9934",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS, BOARD OF OPTOMETRY",
            "identifier": "4901004935",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keisa M Lynch
• Ashley Lyons
• M. Andrew Johnson D.D.S. LC
• Lawrence Walker Macdonald
• Christian David Macnutt
• Aspyn Madsen
• Jeff Madsen, R. PH.
• Melissa Megan Majors
• Jessica Mallory
• James T Malouf, M.D.

• Optometrist in Logan, UT
• Providers in Logan, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.