Provider Demographics
NPI:1497881627
Name:EDLUND, KRISTIAN DAVID (OD)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:DAVID
Last Name:EDLUND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 E MIRACLE STRIP PKWY
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1921
Mailing Address - Country:US
Mailing Address - Phone:850-243-3152
Mailing Address - Fax:850-244-2038
Practice Address - Street 1:251 MARY ESTHER BLVD
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1678
Practice Address - Country:US
Practice Address - Phone:850-243-1160
Practice Address - Fax:850-244-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist