Physician Compare National (NPI:1629208525)

HEALTHCARE PROVIDER: LACEY DUSTIN BEDOY O.D

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629208525
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274675186
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120216000002
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BEDOY
	Individual professional last name
Provider First Name	LACEY
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NEW YORK - STATE COLLEGE OPTOMETRY
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	HARLEM VISION INC.
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6901081892
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	454 LENOX AVE
	Group Practice or individual's line 1 address
City	NEW YORK
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	100373320
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2123682020
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y