Healthcare Provider Details

I. General information

NPI: 1144245200
Provider Name (Legal Business Name): DAVID J EDINGER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-4412
US

IV. Provider business mailing address

2500 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-4412
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-3937
  • Fax: 850-522-9829
Mailing address:
  • Phone: 850-784-3937
  • Fax: 850-522-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP 1635
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP 1635
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOP 1635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: