Provider Demographics
NPI:1548995509
Name:EDWARDS, TAYLOR WATKINS (OD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:WATKINS
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-0608
Mailing Address - Country:US
Mailing Address - Phone:662-473-2181
Mailing Address - Fax:662-473-2161
Practice Address - Street 1:302 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-3032
Practice Address - Country:US
Practice Address - Phone:662-473-2181
Practice Address - Fax:662-473-2161
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1051P-Y152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist