Provider Demographics
NPI:1306883095
Name:STEEDLY, LARRY R (OD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:R
Last Name:STEEDLY
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 1:3561 STEDMAN CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7598
Mailing Address - Country:US
Mailing Address - Phone:910-964-5407
Mailing Address - Fax:
Practice Address - Street 1:4601 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-2138
Practice Address - Country:US
Practice Address - Phone:910-488-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093R8Medicaid
U82590Medicare UPIN
NC2599408BMedicare ID - Type Unspecified