Healthcare Provider Details

I. General information

NPI: 1639131204
Provider Name (Legal Business Name): BETSY JOY HANCOCK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 E 7TH ST
BLOOMSBURG PA
17815-2853
US

IV. Provider business mailing address

273 E 7TH ST
BLOOMSBURG PA
17815-2853
US

V. Phone/Fax

Practice location:
  • Phone: 570-784-2131
  • Fax: 570-389-7670
Mailing address:
  • Phone: 570-784-2131
  • Fax: 570-389-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOE006887-T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: