Provider Demographics
NPI:1528887395
Name:BISHOP, STARK ADAM (OD, MS)
Entity type:Individual
Prefix:DR
First Name:STARK
Middle Name:ADAM
Last Name:BISHOP
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 S CORNELL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1611
Mailing Address - Country:US
Mailing Address - Phone:813-507-1717
Mailing Address - Fax:
Practice Address - Street 1:2060 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5074
Practice Address - Country:US
Practice Address - Phone:708-891-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist