Individual
DR. JOHN D EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
101 N RANDALL AVE, ELK CITY, OK 73644-5231
(580) 225-1980
(580) 225-8648
Mailing address
PO BOX 624, ELK CITY, OK 73648-0624
(580) 225-1980
(580) 225-8648
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
958
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100759880B
—
OK
01
—
410027999
RAILROAD PROVIDER #
OK
01
—
731122948002
DEPT OF REHABILITATIVE SE
OK
Enumeration date
03/29/2006
Last updated
07/26/2011
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