Provider Demographics
NPI:1437377561
Name:JAMES A EDWARDS OD PC
Entity Type:Organization
Organization Name:JAMES A EDWARDS OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:580-248-5280
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK976261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4946483990001OtherBLUE CROSS AND BLUE SHIEL
05731OtherSPECTERA
OKOK0976OtherEYEMED VISIONCARE
OK4946483990001OtherBLUE CROSS AND BLUE SHIEL
OKO0431Medicare UPIN