MEDICARE: STEVE EDWARDS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679762207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVE EDWARDS

Provider Business Mailing Address
First Line	:	PO BOX 785
Second Line	:
City	:	WATER VALLEY
State	:	MS
Zip	:	38965-0785
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 RAILROAD ST
Second Line	:
City	:	WATER VALLEY
State	:	MS
Zip	:	38965-3032
Country	:	US
Telephone Number	:	662-473-2181
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE EDWARDS
Credential	:
Telephone Number	:	662-473-2181

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	11/04/2021

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