Organization
THOMAS E. EDWARDS, O.D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS EDWARDS O.D. (PRESIDENT)
(765) 647-6883
Entity
Organization
Contact information
Practice address
10054 COOLEY RD, BROOKVILLE, IN 47012-9511
(765) 647-6883
(765) 647-6883
Mailing address
10054 COOLEY RD, BROOKVILLE, IN 47012-9511
(765) 647-6883
(765) 647-6883
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001538B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001
VSP
—
01
—
0168170002
DME MEDICARE
IN
05
—
100153310B
—
IN
01
—
5059021
AETNA
—
01
—
IN1538
EYE MED
—
Enumeration date
01/06/2011
Last updated
04/27/2015
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