Provider Demographics
NPI:1316966690
Name:EDLUND,, GEORGE D (OD, PA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:EDLUND,
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93944Medicare UPIN
FL5747910001Medicare NSC