Provider Demographics
NPI:1396753059
Name:EDWARDS, ROBERT P (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8309 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2170
Mailing Address - Country:US
Mailing Address - Phone:309-693-9540
Mailing Address - Fax:309-306-9001
Practice Address - Street 1:3055 WABASH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704
Practice Address - Country:US
Practice Address - Phone:217-793-2273
Practice Address - Fax:217-793-2278
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37914Medicare UPIN
IL205022Medicare ID - Type Unspecified