MEDICARE: SHARON E EDWARDS OD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5393TG	TX

General Provider Information

NPI Number	:	1558854273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARON E EDWARDS OD PLLC

Provider Business Mailing Address
First Line	:	2301 W PARK ROW DR
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3346
Country	:	US
Telephone Number	:	817-460-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 W PARK ROW DR
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3346
Country	:	US
Telephone Number	:	817-460-5333
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHARON EDWARDS
Credential	:
Telephone Number	:	817-460-5333

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	10/10/2018

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