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Individual

DR. THOMAS C EDEWAARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
705 OLD TROLLEY RD, SUITE A, SUMMERVILLE, SC 29485-5212
(843) 821-9300
(843) 821-9300
Mailing address
705 OLD TROLLEY RD, SUITE A, SUMMERVILLE, SC 29485-5212
(843) 821-9300
(843) 821-9300

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
SC972
SC
152WC0802X
Corneal and Contact Management Optometrist
Primary
SC972
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
410023170
RAILROAD MEDICARE
SC
05
D09729
SC
Enumeration date
07/04/2006
Last updated
03/25/2009
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