Individual
DOUGLAS WAYNE ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1906 FAIRVIEW AVE, CALDWELL, ID 83605-5407
(208) 459-2020
(208) 459-2034
Mailing address
420 E ELM ST, CALDWELL, ID 83605-4846
(208) 459-2020
(208) 459-2034
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100406
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ODP100406
OPTOMETRY LICENSE
ID
Enumeration date
06/15/2017
Last updated
06/16/2018
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