1417973959 NPI number — BETHLEHEM EYE CARE ASSOCIATES, P. C.

Table of content: (NPI 1417973959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417973959 NPI number — BETHLEHEM EYE CARE ASSOCIATES, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHLEHEM EYE CARE ASSOCIATES, 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:
BETHLEHEM EYE CARE ASSOCIATES, P. C.
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:
1417973959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
547 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18018-5810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-866-5815
Provider Business Mailing Address Fax Number:
610-866-2450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
547 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18018-5810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-866-5815
Provider Business Practice Location Address Fax Number:
610-866-2450
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRASNICKE
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-866-5815

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0643140001 . This is a "DMERCA (DURABLE MEDICAL)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 04171936000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02827400 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100737745 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000641470 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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