=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700124674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YORK EYE OPTICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2013
-----------------------------------------------------
Last Update Date | 01/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 PINE GROVE COMMONS
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17403-5161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-755-2020
-----------------------------------------------------
Fax | 717-747-3280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 PINE GROVE COMMONS
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17403-5161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-755-2020
-----------------------------------------------------
Fax | 717-747-3280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DAVID J BENE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 717-755-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------