Provider Demographics
NPI:1528162849
Name:M. SCOTT EDWARDS, OD, PA
Entity type:Organization
Organization Name:M. SCOTT EDWARDS, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-398-3534
Mailing Address - Street 1:201 N WYNN ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-1436
Mailing Address - Country:US
Mailing Address - Phone:252-398-3534
Mailing Address - Fax:252-398-3535
Practice Address - Street 1:201 N WYNN ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-1436
Practice Address - Country:US
Practice Address - Phone:252-398-3534
Practice Address - Fax:252-398-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09248OtherSTATE OF NORTH CAROLINA
NC09248OtherDIVISION OF SERVICES BLIN
NC09248OtherBLUE CROSS BLUE SHIELD
NC8909248Medicaid
NC=========OtherWAUSAU
NC=========OtherMEDCOST
NC09248OtherBLUE CROSS BLUE SHIELD
NC=========OtherBENEFIT PLANNERS
NC=========OtherPACIFICARE
NC=========OtherTRICARE
NC09248OtherSTATE OF NORTH CAROLINA
NC8909248Medicaid
NC=========OtherSUMMIT HEALTHCARE
NC09248OtherBLUE CROSS BLUE SHIELD