Provider Demographics
NPI:1336918036
Name:EDMONDS, STEVEN CHARLES
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHARLES
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2117
Mailing Address - Country:US
Mailing Address - Phone:740-594-3718
Mailing Address - Fax:740-594-3469
Practice Address - Street 1:929 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2117
Practice Address - Country:US
Practice Address - Phone:740-594-3718
Practice Address - Fax:740-594-3469
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017679-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician