Provider Demographics
NPI:1013924893
Name:EDWARDS, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15708 POMERADO RD
Mailing Address - Street 2:SUITE N 202
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2066
Mailing Address - Country:US
Mailing Address - Phone:858-485-5600
Mailing Address - Fax:858-485-5692
Practice Address - Street 1:15708 POMERADO RD
Practice Address - Street 2:SUITE N 202
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2066
Practice Address - Country:US
Practice Address - Phone:858-485-5600
Practice Address - Fax:858-485-5692
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180025388OtherRAILROAD MEDICARE PTAN
CA180025388OtherRAILROAD MEDICARE PTAN