Provider Demographics
NPI:1417973959
Name:BETHLEHEM EYE CARE ASSOCIATES, P. C.
Entity Type:Organization
Organization Name:BETHLEHEM EYE CARE ASSOCIATES, P. C.
Other - Org Name:BETHLEHEM EYE CARE ASSOCIATES, P. C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRASNICKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-866-5815
Mailing Address - Street 1:547 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5810
Mailing Address - Country:US
Mailing Address - Phone:610-866-5815
Mailing Address - Fax:610-866-2450
Practice Address - Street 1:547 MAIN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5810
Practice Address - Country:US
Practice Address - Phone:610-866-5815
Practice Address - Fax:610-866-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 332H00000X
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0643140001OtherDMERCA (DURABLE MEDICAL)
PA04171936000OtherINDEPENDENCE BLUE CROSS
PA02827400OtherCAPITAL BLUE CROSS
PA100737745Medicaid
PA000641470OtherHIGHMARK BLUE SHIELD
PA04171936000OtherINDEPENDENCE BLUE CROSS
PA100737745Medicaid