Provider Demographics
NPI:1932229218
Name:GUNTHER, EDMUND A (OD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:A
Last Name:GUNTHER
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 1:6949 BEACH DR SW # 2
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-5739
Mailing Address - Country:US
Mailing Address - Phone:910-575-6700
Mailing Address - Fax:
Practice Address - Street 1:6949 BEACH DR SW # 2
Practice Address - Street 2:
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-5739
Practice Address - Country:US
Practice Address - Phone:910-575-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890933KMedicaid