Provider Demographics
NPI:1619133261
Name:EDWARDS, KYLE BURKE (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:BURKE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:7824 HICKORY FLAT HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6574
Mailing Address - Country:US
Mailing Address - Phone:770-479-0222
Mailing Address - Fax:855-715-4149
Practice Address - Street 1:7824 HICKORY FLAT HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6574
Practice Address - Country:US
Practice Address - Phone:770-479-0222
Practice Address - Fax:855-715-4149
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2014-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT002461152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist