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General NPI Number Information
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NPI Number | 1124298401
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Entity Type | Organization
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Legal Business Name | GEORGE D. EDLUND O.D., P.A.
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 50 NE EGLIN PARKWAY
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4957
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Country | US
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Telephone | 850-244-5577
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Fax | 850-244-4868
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Provider Business Mailing Address
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Address Line | 50 NE EGLIN PARKWAY
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4957
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Country | US
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Telephone | 850-244-5577
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Fax | 850-244-4868
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | GEORGE D. EDLUND
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Credential | O.D., P.A.
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Telephone | 850-244-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OP0002174
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License Number State | FL
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