Provider Demographics
NPI:1730191602
Name:ADAMS, JOHN MURRAY (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MURRAY
Last Name:ADAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5449
Mailing Address - Country:US
Mailing Address - Phone:270-683-2020
Mailing Address - Fax:270-686-0000
Practice Address - Street 1:411 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5449
Practice Address - Country:US
Practice Address - Phone:270-683-2020
Practice Address - Fax:270-686-0000
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1576DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001089Medicaid
KY77001089Medicaid
KY0550111Medicare PIN
KY0550206Medicare PIN