Provider Demographics
NPI:1033365507
Name:EDWARDS, JEFFREY WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:EDWARDS
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 1:2204 1/2 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1221
Mailing Address - Country:US
Mailing Address - Phone:580-255-9717
Mailing Address - Fax:
Practice Address - Street 1:2204 1/2 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1221
Practice Address - Country:US
Practice Address - Phone:580-255-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist