Provider Demographics
NPI:1184715112
Name:BEDSOLE, STEPHANIE B (OD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:B
Last Name:BEDSOLE
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 1:2100 DEVEREUX CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2558
Mailing Address - Country:US
Mailing Address - Phone:205-514-8085
Mailing Address - Fax:866-681-5007
Practice Address - Street 1:1800 MCFARLAND BLVD E STE 337
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5882
Practice Address - Country:US
Practice Address - Phone:205-879-2221
Practice Address - Fax:205-879-0615
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA36TA590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51522034OtherBCBS
AL051554725Medicaid
AL529920130Medicaid