Provider Demographics
NPI:1952658023
Name:HEDGES, LACEY DAWN (OD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:DAWN
Last Name:HEDGES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11261 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1669
Mailing Address - Country:US
Mailing Address - Phone:913-261-2020
Mailing Address - Fax:913-261-2090
Practice Address - Street 1:5811 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1494
Practice Address - Country:US
Practice Address - Phone:913-261-2020
Practice Address - Fax:913-261-2090
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1917152W00000X
MO2012027800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4050D0007Medicare PIN
KS405E00010Medicare PIN
MO4050H0007Medicare PIN
MO4050A0008Medicare PIN