Provider Demographics
NPI:1043595192
Name:HEDGES, STEPHEN B (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:HEDGES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14128 W NEWBERRY RD STE 40
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3447
Mailing Address - Country:US
Mailing Address - Phone:352-309-2021
Mailing Address - Fax:352-309-2024
Practice Address - Street 1:14128 W NEWBERRY RD STE 40
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3447
Practice Address - Country:US
Practice Address - Phone:352-309-2021
Practice Address - Fax:352-309-2024
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ094ZMedicare Oscar/Certification