Healthcare Provider Details

I. General information

NPI: 1760717961
Provider Name (Legal Business Name): THE BERNSTEIN HILLIKER HARTZELL OPTICAL SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 N SUSQUEHANNA TRL
SHAMOKIN DAM PA
17876-9113
US

IV. Provider business mailing address

3020 N SUSQUEHANNA TRL
SHAMOKIN DAM PA
17876-9113
US

V. Phone/Fax

Practice location:
  • Phone: 570-743-5367
  • Fax: 570-743-5104
Mailing address:
  • Phone: 570-743-5367
  • Fax: 570-743-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number332BC3200X
License Number StatePA

VIII. Authorized Official

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