1396980884 NPI number — BETTS AND BIDDLE EYE CARE PA

Table of content: (NPI 1396980884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396980884 NPI number — BETTS AND BIDDLE EYE CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTS AND BIDDLE EYE CARE PA
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:
1396980884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8500 HERRING RUN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEAFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19973-5795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-629-6691
Provider Business Mailing Address Fax Number:
302-629-7963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 HERRING RUN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEAFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19973-5795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-629-6691
Provider Business Practice Location Address Fax Number:
302-629-7963
Provider Enumeration Date:
12/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DEMOTT
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
302-629-6691

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  I30001197 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4523347 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 256256 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: U20423 . This is a "MID ATLANTIC HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510252R89 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510252212 . This is a "TRICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1124071899 . This is a "NPI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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