Provider Demographics
NPI:1710546452
Name:EDELBI, RANDA (OD)
Entity Type:Individual
Prefix:
First Name:RANDA
Middle Name:
Last Name:EDELBI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11353 ANDREW LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5507
Mailing Address - Country:US
Mailing Address - Phone:571-268-4391
Mailing Address - Fax:
Practice Address - Street 1:3808 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5208
Practice Address - Country:US
Practice Address - Phone:703-961-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2003-949AT152W00000X
VA0618002757152W00000X
FLOPC5654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist