1376522862 NPI number — MT. BETHEL EYE CARE, P.C.

Table of content: (NPI 1376522862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376522862 NPI number — MT. BETHEL EYE CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT. BETHEL EYE CARE, P.C.
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:
Provider Other Organization Name Type Code:
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:
1376522862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MOUNT BETHEL PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT BETHEL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18343-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-897-5911
Provider Business Mailing Address Fax Number:
570-897-5908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MOUNT BETHEL PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT BETHEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18343-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-897-5911
Provider Business Practice Location Address Fax Number:
570-897-5908
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIMARCO
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT / OPTOMETRIST
Authorized Official Telephone Number:
570-897-5911

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000111 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: OEG000111 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 465212 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 751252 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02095801 . This is a "KEYSTONE SENIOR BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 751252 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02095801 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 176529873 . This is a "AMERIHEALTH ADM." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02886800 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02886800 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G521252 . This is a "AMERIHEALTH ADM." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1253981001 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5708975911 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02095801 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02886800 . This is a "KEYSTONE SENIOR BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 396396 . This is a "NATIONAL VISION ADM." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 751252 . This is a "KEYSTONE SENIOR BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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