Provider Demographics
NPI:1578689832
Name:EDELSBERG, KAY P (OD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:P
Last Name:EDELSBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19575 BISCAYNE BLVD
Mailing Address - Street 2:# 579
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2325
Mailing Address - Country:US
Mailing Address - Phone:305-935-2999
Mailing Address - Fax:
Practice Address - Street 1:19575 BISCAYNE BLVD
Practice Address - Street 2:# 579
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2325
Practice Address - Country:US
Practice Address - Phone:305-935-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1829152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist