Healthcare Provider Details

I. General information

NPI: 1780758730
Provider Name (Legal Business Name): EDINBURGH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W MAIN CROSS ST
EDINBURGH IN
46124-1347
US

IV. Provider business mailing address

210 W MAIN CROSS ST
EDINBURGH IN
46124-1347
US

V. Phone/Fax

Practice location:
  • Phone: 812-526-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003247A
License Number StateIN

VIII. Authorized Official

Name: DR. MARSHALL WAYNE ZAMORA
Title or Position: PARTNER
Credential: O.D.
Phone: 812-526-7444