Healthcare Provider Details

I. General information

NPI: 1942279138
Provider Name (Legal Business Name): JAMES J BEDRICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 RANDOLPH RD SUITE 108
CHARLOTTE NC
28207-1200
US

IV. Provider business mailing address

2025 DELPOND LN
CHARLOTTE NC
28226-6467
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-2020
  • Fax: 704-334-2020
Mailing address:
  • Phone: 704-334-2020
  • Fax: 704-334-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number26082
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14216
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: