Provider Demographics
NPI:1811205099
Name:CATHY EDWARDS O.D. LLC
Entity Type:Organization
Organization Name:CATHY EDWARDS O.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-226-5850
Mailing Address - Street 1:100 COMMERCIAL LN
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64856-7069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 COMMERCIAL LN
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64856-7069
Practice Address - Country:US
Practice Address - Phone:417-226-5850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty