Provider Demographics
NPI:1669450359
Name:EDNEY, RICHARD VANCE (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:VANCE
Last Name:EDNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SHUFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-7406
Mailing Address - Country:US
Mailing Address - Phone:828-894-3930
Mailing Address - Fax:
Practice Address - Street 1:69 SHUFORD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-7406
Practice Address - Country:US
Practice Address - Phone:828-894-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1256152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC180040941OtherPALMETTO GBA
NC0917QOtherBCBS OF NC
NC890925AMedicaid
NC0917QOtherBCBS OF NC
NC6372770001Medicare NSC
NC180040941OtherPALMETTO GBA