Provider Demographics
NPI:1952386179
Name:EDWARDS, THOMAS E (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
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 1:10054 COOLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-9511
Mailing Address - Country:US
Mailing Address - Phone:765-647-6883
Mailing Address - Fax:765-647-6883
Practice Address - Street 1:10054 COOLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-9511
Practice Address - Country:US
Practice Address - Phone:765-647-6883
Practice Address - Fax:765-647-6883
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001538B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100153310BMedicaid
0001OtherVSP
5059021OtherAETNA
IN1538OtherEYE MED
IN0168170002OtherDME MEDICARE
IN0168170002OtherDME MEDICARE