Healthcare Provider Details

I. General information

NPI: 1740071836
Provider Name (Legal Business Name): KATELYNN EDWARDS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST STE 6
MIAMI FL
33136-1134
US

IV. Provider business mailing address

900 NW 17TH ST STE 6
MIAMI FL
33136-1119
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: