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
- Phone: 570-897-5911
- Fax: 570-897-5908
- Phone: 570-897-5911
- Fax: 570-897-5908
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WC0802X |
| Taxonomy | Corneal and Contact Management Optometrist |
| License Number | OEG000111 |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | OEG000111 |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 02095801 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | KEYSTONE |
| # 2 | |
| Identifier | 02886800 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | CAPITAL BLUE CROSS |
| # 3 | |
| Identifier | 751252 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | KEYSTONE |
| # 4 | |
| Identifier | 02095801 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | KEYSTONE SENIOR BLUE |
| # 5 | |
| Identifier | 02095801 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | CAPITAL BLUE CROSS |
| # 6 | |
| Identifier | 751252 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HIGHMARK BLUE SHIELD |
| # 7 | |
| Identifier | 02886800 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | KEYSTONE SENIOR BLUE |
| # 8 | |
| Identifier | 751252 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | KEYSTONE SENIOR BLUE |
| # 9 | |
| Identifier | 02886800 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | KEYSTONE |
| # 10 | |
| Identifier | 1253981001 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | CIGNA |
| # 11 | |
| Identifier | 396396 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | NATIONAL VISION ADM. |
| # 12 | |
| Identifier | 5708975911 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | VISION SERVICE PLAN |
| # 13 | |
| Identifier | G521252 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AMERIHEALTH ADM. |
| # 14 | |
| Identifier | 176529873 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AMERIHEALTH ADM. |
| # 15 | |
| Identifier | 465212 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AETNA |
VIII. Authorized Official
Name: DR.
STEPHEN
DIMARCO
Title or Position: PRESIDENT / OPTOMETRIST
Credential: O.D.
Phone: 570-897-5911
