Individual
DR. ADAM LARRY MADDOCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1150 S 100 W, LOGAN, UT 84321-5573
(435) 754-3459
(435) 787-8498
Mailing address
1150 S 100 W, LOGAN, UT 84321-5573
(435) 754-3459
(435) 787-8498
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10295884-9934
UT
152W00000X
Optometrist
4901004935
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10295884-9934
UTAH DEPARTMENT OF COMMERCE, DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING
UT
01
—
4901004935
MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS, BOARD OF OPTOMETRY
MI
Enumeration date
09/29/2015
Last updated
02/25/2019
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