Provider Demographics
NPI:1164592523
Name:BEDSOLE, DOYLE S (OD)
Entity Type:Individual
Prefix:DR
First Name:DOYLE
Middle Name:S
Last Name:BEDSOLE
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 1:101 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6148
Mailing Address - Country:US
Mailing Address - Phone:919-847-0051
Mailing Address - Fax:919-846-9003
Practice Address - Street 1:101 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6148
Practice Address - Country:US
Practice Address - Phone:919-847-0051
Practice Address - Fax:919-846-9003
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2348490OtherGROUP PTAN
NC1164592523OtherNPI
NC2466989AOtherPTAN
NC1831258912OtherGROUP NPI
NC2348490OtherGROUP PTAN