Individual
ROBERT EDWARD EDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1206 COLLEGE AVE, JACKSON, AL 36545-2407
(251) 246-3231
(251) 246-3034
Mailing address
2880 DAUPHIN ST, MOBILE, AL 36606-2457
(251) 470-8820
(251) 470-8943
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S412TA033
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2210129
UNITED HEALTHCARE PROV #
AL
01
—
4386054
AETNA PROVIDER #
AL
01
—
51076025
BLUE CROSS OF AL PROV #
AL
01
—
T69193
HEALTHSPRING PROVIDER #
AL
Enumeration date
05/27/2005
Last updated
11/19/2007
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