Provider Demographics
NPI:1104847425
Name:SAMMONS, EDWARD D (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:SAMMONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5810
Mailing Address - Country:US
Mailing Address - Phone:912-352-7941
Mailing Address - Fax:912-352-7946
Practice Address - Street 1:2 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5810
Practice Address - Country:US
Practice Address - Phone:912-352-7941
Practice Address - Fax:912-352-7946
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002183152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA880346501AMedicaid
V00779Medicare UPIN
GA412CFP5Medicare ID - Type UnspecifiedMEDICARE