Provider Demographics
NPI:1609003359
Name:EDWARDS, MEGAN
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 RT 9
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804
Mailing Address - Country:US
Mailing Address - Phone:518-761-4139
Mailing Address - Fax:518-761-0488
Practice Address - Street 1:891 ROUTE 9
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1744
Practice Address - Country:US
Practice Address - Phone:518-761-4139
Practice Address - Fax:518-761-0488
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007658-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician