Healthcare Provider Details

I. General information

NPI: 1104458397
Provider Name (Legal Business Name): BERNSTEIN HILLIKER HARTZELL OPTICAL SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 QUEEN ST
NORTHUMBERLAND PA
17857-1906
US

IV. Provider business mailing address

88 HARDEES DR
MIFFLINBURG PA
17844-7062
US

V. Phone/Fax

Practice location:
  • Phone: 866-995-3937
  • Fax: 570-966-5586
Mailing address:
  • Phone: 866-995-3937
  • Fax: 570-966-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY RINE
Title or Position: VICE PRESIDENT
Credential:
Phone: 570-966-5582