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Individual

MR. CORYDON G EDGECOMB

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1287 BROADWAY, SUITE 1, PLACERVILLE, CA 95667-5805
(530) 622-7660
(530) 622-3753
Mailing address
1287 BROADWAY, SUITE 1, PLACERVILLE, CA 95667-5805
(530) 622-7660
(530) 622-3753

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4245T
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
S00042450
CA
Enumeration date
07/21/2006
Last updated
08/19/2010
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