Provider Demographics
NPI:1841206372
Name:BRADY, BETHANY HILTERMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:HILTERMAN
Last Name:BRADY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:HILTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7376 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARBORCREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16421-1405
Mailing Address - Country:US
Mailing Address - Phone:814-873-0792
Mailing Address - Fax:
Practice Address - Street 1:1600 PENINSULA DR STE 15
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4261
Practice Address - Country:US
Practice Address - Phone:814-920-5010
Practice Address - Fax:814-920-5070
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0076225210002Medicaid
PAU73472Medicare UPIN
PA022881Medicare PIN