1295935575 NPI number — BELLEVUE VISION CO

Table of content: (NPI 1295935575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295935575 NPI number — BELLEVUE VISION CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLEVUE VISION CO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BENJAMIN N FABI
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295935575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
568 LINCOLN AVE
Provider Second Line Business Mailing Address:
PO BOX 41088
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15202-3530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-734-3344
Provider Business Mailing Address Fax Number:
412-734-3344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
568 LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15202-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-734-3344
Provider Business Practice Location Address Fax Number:
412-734-3344
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FABI
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
NORONA
Authorized Official Title or Position:
OWNER OPTICIAN
Authorized Official Telephone Number:
412-734-3344

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  6000002744 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0015184000003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BE280369 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 393046 . This is a "NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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