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NPI Code Detail

MEDICARE: MR. ROBERT LEE EDWARDS III LDO

MEDICARE: MR. ROBERT LEE EDWARDS III LDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician2999IAZ

General Provider Information

NPI Number : 1235910738
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT LEE EDWARDS III LDO
Provider Business Mailing Address
First Line : 7769 N WINDING TRL
Second Line :
City : PRESCOTT VALLEY
State : AZ
Zip : 86315-3095
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3450 N GLASSFORD HILL RD
Second Line :
City : PRESCOTT VALLEY
State : AZ
Zip : 86314-1351
Country : US
Telephone Number : 928-499-3152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2023
Last Update Date : 10/10/2023

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