Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 544 | MS |
NPI | 1013015585 |
---|---|
Provider Name | Stephen Patrick Edwards |
First Address | Holly Springs, MS 38635-2902 |
Second Address | Water Valley, MS 38965-3032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 04/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00880206 | (05) | MS |
T93632 | (02) | MS |