Provider Demographics
NPI:1437135795
Name:LEMON, EDWARD (OD PA)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:LEMON
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-0405
Mailing Address - Country:US
Mailing Address - Phone:803-259-2020
Mailing Address - Fax:803-259-3621
Practice Address - Street 1:267 MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1849
Practice Address - Country:US
Practice Address - Phone:803-259-2020
Practice Address - Fax:803-259-3621
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO7464Medicaid
SCT243990281Medicare PIN