Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG000492 | PA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OEG000492 | PA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OEG000492 | PA |
NPI | 1245276328 |
---|---|
Provider Name | Scott A. Edmonds |
First Address | Drexel Hill, PA 19026-1925 |
Second Address | Drexel Hill, PA 19026-1925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 10/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0062266000 | KEYSTONE (01) | PA |
1422835 | AETNA (01) | PA |
159973 | BLUE CROSS BLUE SHIELD (01) | PA |
T29776 | (02) | PA |