Provider Demographics
NPI:1831194075
Name:BEDINGHAUS, TROY LEE (OD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:LEE
Last Name:BEDINGHAUS
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 1:11151 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
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5374T152W00000X
FLOPC003083152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620337000Medicaid
FL650772437OtherFEDERAL TAX ID NUMBER
FL20816Medicare ID - Type Unspecified
FL620337000Medicaid