Provider Demographics
NPI:1124298401
Name:GEORGE D. EDLUND O.D., P.A.
Entity type:Organization
Organization Name:GEORGE D. EDLUND O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PA
Authorized Official - Phone:850-244-5577
Mailing Address - Street 1:50 NE EGLIN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4957
Mailing Address - Country:US
Mailing Address - Phone:850-244-5577
Mailing Address - Fax:850-244-4868
Practice Address - Street 1:50 NE EGLIN PARKWAY
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4957
Practice Address - Country:US
Practice Address - Phone:850-244-5577
Practice Address - Fax:850-244-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5747910001Medicare NSC