Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OP 1635 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OP 1635 | FL |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OP 1635 | FL |
NPI | 1144245200 |
---|---|
Provider Name | Dr. David J Edinger |
First Address | Panama City, FL 32405-4412 |
Second Address | Panama City, FL 32405-4412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 16/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078241600 | (05) | FL |
19182 | BLUE CROSS & BLUE SHIELD (01) | FL |
410042390 | RR MEDICARE (01) | FL |
T77515 | (02) | FL |