Provider Demographics
NPI:1124033832
Name:BEDOYA EYE CARE P A
Entity Type:Organization
Organization Name:BEDOYA EYE CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-755-7595
Mailing Address - Street 1:4206 NW WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4804
Mailing Address - Country:US
Mailing Address - Phone:386-755-7595
Mailing Address - Fax:386-755-7561
Practice Address - Street 1:876 SW STATE ROAD 247
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-8308
Practice Address - Country:US
Practice Address - Phone:386-755-7595
Practice Address - Fax:386-755-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002016400Medicaid
FLK4330Medicare ID - Type Unspecified
FL6385720001Medicare NSC