Provider Demographics
NPI:1114027901
Name:EDWARDS, JEFF S (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:S
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 1:806 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4222
Mailing Address - Country:US
Mailing Address - Phone:580-326-3319
Mailing Address - Fax:580-326-3310
Practice Address - Street 1:806 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4222
Practice Address - Country:US
Practice Address - Phone:580-326-3319
Practice Address - Fax:580-326-3310
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100766690AMedicaid
OKP00331640OtherRAILROAD MEDICARE
OK5836030001Medicare NSC
OKU43103Medicare UPIN
OKP00331640OtherRAILROAD MEDICARE