Provider Demographics
NPI:1982870846
Name:VORSTER, EDWARD (OD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:VORSTER
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 1:1205 HIGHWAY 327 E
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-6007
Mailing Address - Country:US
Mailing Address - Phone:409-385-2811
Mailing Address - Fax:409-385-6696
Practice Address - Street 1:1205 HIGHWAY 327 E
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-6007
Practice Address - Country:US
Practice Address - Phone:409-385-2811
Practice Address - Fax:409-385-6696
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03287T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121645905Medicaid
TX8F8291Medicare PIN
TX121645905Medicaid