MEDICARE: EDNA ALVARADO OD

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
1	152W00000X	Optometrist	246	PR

General Provider Information

NPI Number	:	1780605196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA ALVARADO OD

Provider Business Mailing Address
First Line	:	6750 IRONGATE DR # B
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2506
Country	:	US
Telephone Number	:	910-578-2974
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 REILLY RD
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7301
Country	:	US
Telephone Number	:	910-907-9262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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