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General NPI Number Information
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NPI Number | 1336155712
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Entity Type | Individual
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Provider Name | KYLE EDWARDS O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1101 HONOR HEIGHTS DR MUSKOGEE VAMC
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City | MUSKOGEE
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State | OK
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Zip | 74401-1302
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Country | US
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Telephone | 918-683-3261
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Fax |
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Provider Business Mailing Address
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Address Line | RR 1 BOX 850
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City | CHECOTAH
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State | OK
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Zip | 74426-9759
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Country | US
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Telephone | 918-473-5507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2330
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License Number State | OK
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