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General NPI Number Information
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NPI Number | 1831114412
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Entity Type | Organization
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Legal Business Name | LEBANON OPHTHALMIC ASSOCIATES
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 770 NORMAN DR
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City | LEBANON
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State | PA
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Zip | 17042-7495
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Country | US
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Telephone | 717-272-2161
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Fax | 717-270-0301
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Provider Business Mailing Address
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Address Line | 770 NORMAN DR
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City | LEBANON
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State | PA
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Zip | 17042-7495
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Country | US
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Telephone | 717-272-2161
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Fax | 717-270-0301
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Authorized Official
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Title or Position | OWNER/OPHTHALMOLOGIST
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Name | DR. JAMES WILLIAM BUSH
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Credential | MD
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Telephone | 717-272-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OE008055T
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License Number State | PA
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