Provider Demographics
NPI:1427208594
Name:REED S EDELMAN OD PA
Entity Type:Organization
Organization Name:REED S EDELMAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REED
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-750-7774
Mailing Address - Street 1:7124 BERACASA WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3448
Mailing Address - Country:US
Mailing Address - Phone:561-750-7744
Mailing Address - Fax:561-392-3200
Practice Address - Street 1:7124 BERACASA WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3448
Practice Address - Country:US
Practice Address - Phone:561-750-7744
Practice Address - Fax:561-392-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84172Medicare PIN
FL0900980001Medicare NSC