Provider Demographics
NPI:1083076624
Name:ANDREW S EDWARDS MD PLLC
Entity Type:Organization
Organization Name:ANDREW S EDWARDS MD PLLC
Other - Org Name:WALLA WALLA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KEITHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-525-2100
Mailing Address - Street 1:299 W TIETAN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4363
Mailing Address - Country:US
Mailing Address - Phone:509-525-2100
Mailing Address - Fax:509-522-0313
Practice Address - Street 1:299 W TIETAN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4363
Practice Address - Country:US
Practice Address - Phone:509-525-2100
Practice Address - Fax:509-522-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60142403207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty