Provider Demographics
NPI:1477660769
Name:JARKA, EDWARD STANLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STANLEY
Last Name:JARKA
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 1:7954 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2717
Mailing Address - Country:US
Mailing Address - Phone:314-962-7580
Mailing Address - Fax:314-962-7580
Practice Address - Street 1:7954 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2717
Practice Address - Country:US
Practice Address - Phone:314-962-7580
Practice Address - Fax:314-962-7580
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1477660769Medicaid
MO991630001Medicare PIN
MO1477660769Medicaid
MO053007473Medicare PIN
U13849Medicare UPIN