Provider Demographics
NPI:1093705345
Name:EDWARDS, JULIA B (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:B
Last Name:EDWARDS
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 1:101 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1108
Mailing Address - Country:US
Mailing Address - Phone:608-846-5625
Mailing Address - Fax:608-846-8998
Practice Address - Street 1:101 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1108
Practice Address - Country:US
Practice Address - Phone:608-846-5625
Practice Address - Fax:608-846-8998
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38573600Medicaid
WI000247800Medicare ID - Type Unspecified
WI38573600Medicaid
WIT16837Medicare UPIN