Provider Demographics
NPI:1790821270
Name:EDWARDS, DONALD Q (LDO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:Q
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LDO
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Mailing Address - Street 1:3131 PIO NONO AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-3027
Mailing Address - Country:US
Mailing Address - Phone:478-781-2159
Mailing Address - Fax:478-746-9865
Practice Address - Street 1:629 N EXPRESSWAY STE D
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2083
Practice Address - Country:US
Practice Address - Phone:770-227-1331
Practice Address - Fax:478-746-9865
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GALDO000683156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician