Provider Demographics
NPI:1619280294
Name:EDWARDS, JEREMY KIYOSHI AOKI (OD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:KIYOSHI AOKI
Last Name:EDWARDS
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 1:950 THARP RD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-8344
Mailing Address - Country:US
Mailing Address - Phone:530-671-7100
Mailing Address - Fax:530-671-7121
Practice Address - Street 1:950 THARP RD
Practice Address - Street 2:SUITE 1500
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-8344
Practice Address - Country:US
Practice Address - Phone:530-671-7100
Practice Address - Fax:530-671-7121
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist