Provider Demographics
NPI:1518999291
Name:EDWARDS, BRENDA CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:CHRISTINE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8800 W 75TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4001
Mailing Address - Country:US
Mailing Address - Phone:913-362-3210
Mailing Address - Fax:913-362-0407
Practice Address - Street 1:8800 W 75TH ST STE 140
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4001
Practice Address - Country:US
Practice Address - Phone:913-362-3210
Practice Address - Fax:913-362-0407
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU05345Medicare UPIN