Provider Demographics
NPI:1215930763
Name:EDWARDS, ALBERT OWEN (MD, PHD)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:OWEN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 VALLEY RIVER WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2127
Mailing Address - Country:US
Mailing Address - Phone:541-762-2763
Mailing Address - Fax:541-434-0912
Practice Address - Street 1:1011 VALLEY RIVER WAY STE 110
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2127
Practice Address - Country:US
Practice Address - Phone:541-762-2763
Practice Address - Fax:541-434-0912
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20042207W00000X, 207WX0108X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR083647Medicaid
OR150077Medicare PIN
OR083647Medicaid