Provider Demographics
NPI:1578560165
Name:EDMUNDS, FRANK MIDDLETON (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:MIDDLETON
Last Name:EDMUNDS
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 1:863 E 600 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4268
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:STE 204
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3374
Practice Address - Country:US
Practice Address - Phone:801-357-7373
Practice Address - Fax:801-357-7217
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1109409934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF0387Medicaid
UTT78116Medicare UPIN
UT000060560Medicare PIN