Provider Demographics
NPI:1639280241
Name:M. SCOTT EDWARDS, OD, PA
Entity Type:Organization
Organization Name:M. SCOTT EDWARDS, OD, PA
Other - Org Name:DOCTORS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-332-5618
Mailing Address - Street 1:1488 MEMORIAL DR E
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3926
Mailing Address - Country:US
Mailing Address - Phone:252-332-5618
Mailing Address - Fax:252-332-5598
Practice Address - Street 1:1488 MEMORIAL DR E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3926
Practice Address - Country:US
Practice Address - Phone:252-332-5618
Practice Address - Fax:252-332-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09249OtherBLUE CROSS BLUE SHIELD
NC09249OtherSTATE OF NORTH CAROLINA
NC8909249OtherDIVISION OF SERVICES BLIN
NC8909249Medicaid
NC09249OtherANTHEM BCBS OF VIRGINIA
NC8909249OtherDIVISION OF SERVICES BLIN
NC=========OtherHUMANA
NC09249OtherSTATE OF NORTH CAROLINA
NC=========OtherBENEFIT PLANNERS
NY=========OtherSUMMITT HEALTHCARE
NC=========OtherBANKERS LIFE/CONSECO
NC=========OtherMAMSI
NC8909249Medicaid
NC09249OtherBLUE CROSS BLUE SHIELD
NC=========OtherWAUSAU
NC=========OtherPHYSICIANS MUTUAL
NC09249OtherANTHEM BCBS OF VIRGINIA
NC=========OtherBENEFIT PLANNERS
NC=========OtherGHI
NC8909249Medicaid