MEDICARE: SUSAN E. EDMONDS 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	OEG000493	PA
2	152WC0802X	Corneal and Contact Management Optometrist	OEG000493	PA
3	152WL0500X	Low Vision Rehabilitation Optometrist	OEG000493	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	429782	OTHER	PA	BLUE CROSS/ BLUE SHIELD
2	0033165000	OTHER	PA	KEYSTONE
3	2545643	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1811944085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E. EDMONDS OD

Provider Business Mailing Address
First Line	:	3300 TOWNSHIP LINE RD
Second Line	:	SUITE 101
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-1925
Country	:	US
Telephone Number	:	610-449-2540
Fax Number	:	610-449-2751

Provider Business Practice Location Address
First Line	:	3300 TOWNSHIP LINE RD
Second Line	:	SUITE 101
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-1925
Country	:	US
Telephone Number	:	610-449-2540
Fax Number	:	610-449-2751

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/10/2008

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Directions to “ SUSAN E. EDMONDS OD” Practice Location

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