Provider Demographics
NPI:1760661177
Name:TROY L BEDINGHAUS OD PA
Entity Type:Organization
Organization Name:TROY L BEDINGHAUS OD PA
Other - Org Name:LAKEWOOD FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BEDINGHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-739-5959
Mailing Address - Street 1:11151 E STATE ROAD 70
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8405
Mailing Address - Country:US
Mailing Address - Phone:941-739-5959
Mailing Address - Fax:941-756-1925
Practice Address - Street 1:11151 E STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8405
Practice Address - Country:US
Practice Address - Phone:941-739-5959
Practice Address - Fax:941-756-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620337000Medicaid
FL4045800001Medicare NSC
FL20816Medicare PIN
FLU69033Medicare UPIN