Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2601TG | TX |
NPI | 1003927476 |
---|---|
Provider Name | Dr. Daniel Neal Edwards |
First Address | Longview, TX 75601-4737 |
Second Address | Longview, TX 75601-4737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T13136 | (02) | TX |