=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861443525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD CHARLES BEDELL O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 11/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2070 SAM RITTENBERG BLVD
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-4605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-810-0634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1036
-----------------------------------------------------
City | ISLE OF PALMS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29451-1036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-810-0634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0618001482
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1487
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------