Provider Demographics
NPI:1447567573
Name:EDGAR H. ALDERMAN, O.D., P.C.
Entity Type:Organization
Organization Name:EDGAR H. ALDERMAN, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-832-0144
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-0178
Mailing Address - Country:US
Mailing Address - Phone:308-832-0144
Mailing Address - Fax:308-832-0737
Practice Address - Street 1:110 E HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1971
Practice Address - Country:US
Practice Address - Phone:308-832-0144
Practice Address - Fax:308-832-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025874300Medicaid
E71405Medicare UPIN
NE10025874300Medicaid
NE0587700001Medicare NSC