Provider Demographics
NPI:1841223831
Name:BEDFORD EYECARE, P.A.
Entity type:Organization
Organization Name:BEDFORD EYECARE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOURQUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-960-2020
Mailing Address - Street 1:2400 AIRPORT FWY STE 140
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6098
Mailing Address - Country:US
Mailing Address - Phone:972-960-2020
Mailing Address - Fax:972-960-2063
Practice Address - Street 1:2400 AIRPORT FWY STE 140
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6098
Practice Address - Country:US
Practice Address - Phone:817-284-2964
Practice Address - Fax:817-283-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5376TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L4564OtherINDIVIDUAL PTAN
TX8L4564OtherINDIVIDUAL PTAN
TXU67717Medicare UPIN