Provider Demographics
NPI:1174631691
Name:EDWARDS, JAMES ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALAN
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 1:409 SW C AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4022
Mailing Address - Country:US
Mailing Address - Phone:580-248-5280
Mailing Address - Fax:580-357-0301
Practice Address - Street 1:409 SW C AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4022
Practice Address - Country:US
Practice Address - Phone:580-248-5280
Practice Address - Fax:580-357-0301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicare PIN