Provider Demographics
NPI:1962659995
Name:EDER, LAUREN RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:RENEE
Last Name:EDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:RENEE
Other - Last Name:BUMGARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:105 MOREY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1647
Practice Address - Country:US
Practice Address - Phone:937-642-2002
Practice Address - Fax:937-642-3620
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4266771OtherPTAN