Provider Demographics
NPI:1285931709
Name:EDMONDS & ASSOCIATES LLC
Entity type:Organization
Organization Name:EDMONDS & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-449-2540
Mailing Address - Street 1:3300 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1925
Mailing Address - Country:US
Mailing Address - Phone:610-449-2540
Mailing Address - Fax:610-449-2751
Practice Address - Street 1:3300 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1925
Practice Address - Country:US
Practice Address - Phone:610-449-2540
Practice Address - Fax:610-449-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA212679Medicare PIN
PA6581370001Medicare NSC