Provider Demographics
NPI:1417987512
Name:EDEWAARD, THOMAS C (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:EDEWAARD
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 1:705 OLD TROLLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5212
Mailing Address - Country:US
Mailing Address - Phone:843-821-9300
Mailing Address - Fax:843-821-9300
Practice Address - Street 1:705 OLD TROLLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5212
Practice Address - Country:US
Practice Address - Phone:843-821-9300
Practice Address - Fax:843-821-9300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC972152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410023170OtherRAILROAD MEDICARE
SCD09729Medicaid
SC410023170OtherRAILROAD MEDICARE
SC0958180001Medicare NSC