Provider Demographics
NPI:1750339370
Name:EDWARDS, CAROLYN S (OD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:S
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5822
Mailing Address - Country:US
Mailing Address - Phone:918-423-2031
Mailing Address - Fax:918-423-2115
Practice Address - Street 1:602 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5822
Practice Address - Country:US
Practice Address - Phone:918-423-2031
Practice Address - Fax:918-423-2115
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK933152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731175347002OtherBLUECROSSBLUESHIELD OPTIA
OK731175347002OtherCIGNA
OK100768860BMedicaid
OK100763220 AMedicaid
OKOKA100394OtherPTAN
OKU39963Medicare UPIN
OK100763220 AMedicaid
OK100768860BMedicaid
OK242418303Medicare ID - Type UnspecifiedPROFESSIONAL