Provider Demographics
NPI:1477638724
Name:ALDERMAN, EDGAR H (OD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:H
Last Name:ALDERMAN
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:PO BOX 178
Mailing Address - Street 2:110 E. HAWTHORNE ST.
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-0178
Mailing Address - Country:US
Mailing Address - Phone:308-832-0144
Mailing Address - Fax:308-832-0737
Practice Address - Street 1:110 E HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1912
Practice Address - Country:US
Practice Address - Phone:308-832-0144
Practice Address - Fax:308-832-0737
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025874300Medicaid
NE6788OtherBCBS
NEE71405Medicare UPIN
NE094511Medicare PIN
NE6788OtherBCBS