Active NPI
Robert Edward Edge, O.D.
- Optometrist
- Jackson, AL
National Provider Identifier
1659374361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- S412TA033
- Practice address
- 1206 College Ave
Jackson, AL 36545-2407 - Phone
- (251) 246-3231
- Fax
- (251) 246-3034
- NPI assigned
- May 27, 2005
- Last updated
- Nov 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | S412TA033 | AL | Primary |
Addresses
Primary practice location
1206 College Ave
Jackson, AL 36545-2407
Mailing address
2880 Dauphin St
Mobile, AL 36606-2457
Phone (251) 470-8820
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| T69193 | Other | AL | HEALTHSPRING PROVIDER # |
| 51076025 | Other | AL | BLUE CROSS OF AL PROV # |
| 2210129 | Other | AL | UNITED HEALTHCARE PROV # |
| 4386054 | Other | AL | AETNA PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S412TA033 | AL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195430400000",
"number": "1659374361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2880 DAUPHIN ST",
"city": "MOBILE",
"state": "AL",
"postal_code": "366062457",
"telephone_number": "251-470-8820",
"fax_number": "251-470-8943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1206 COLLEGE AVE",
"city": "JACKSON",
"state": "AL",
"postal_code": "365452407",
"telephone_number": "251-246-3231",
"fax_number": "251-246-3034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDGE",
"first_name": "ROBERT",
"middle_name": "EDWARD",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-27",
"last_updated": "2007-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AL",
"license": "S412TA033",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHSPRING PROVIDER #",
"identifier": "T69193",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF AL PROV #",
"identifier": "51076025",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE PROV #",
"identifier": "2210129",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER #",
"identifier": "4386054",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.