Healthcare Provider Details

I. General information

NPI: 1376522862
Provider Name (Legal Business Name): MT BETHEL EYE CARE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MOUNT BETHEL PLZ
MOUNT BETHEL PA
18343-5212
US

IV. Provider business mailing address

9 MOUNT BETHEL PLZ
MOUNT BETHEL PA
18343-5212
US

V. Phone/Fax

Practice location:
  • Phone: 570-897-5911
  • Fax: 570-897-5908
Mailing address:
  • Phone: 570-897-5911
  • Fax: 570-897-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000111
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG000111
License Number StatePA

VIII. Authorized Official

Name: DR. STEPHEN DIMARCO
Title or Position: PRESIDENT / OPTOMETRIST
Credential: O.D.
Phone: 570-897-5911