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Organization

DAVID S. EDMONDS OD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID SCOTT EDMONDS OD (PRESIDENT)
(912) 537-2436
Entity
Organization

Contact information

Practice address
3109 E 1ST ST, VIDALIA, GA 30474-8830
(912) 537-2436
(912) 537-2659
Mailing address
3109 E 1ST ST, VIDALIA, GA 30474-8830
(912) 537-2436
(912) 537-2659

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
5027-T1904
OH
152W00000X
Optometrist
975-OD
WV
152W00000X
Optometrist
Primary
OPT002008
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
496302301A
GA
Enumeration date
08/10/2007
Last updated
08/04/2015
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