Healthcare Provider Details

I. General information

NPI: 1326613308
Provider Name (Legal Business Name): HUNTER EDWARDS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RAILROAD ST
WATER VALLEY MS
38965-3032
US

IV. Provider business mailing address

107 WESTBURY CIR
OXFORD MS
38655-6046
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-2181
  • Fax:
Mailing address:
  • Phone: 662-614-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1035P-Y
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: