Provider Demographics
NPI:1255432787
Name:BERNSTEIN, HILLIKER, HARTZELL OPTICAL SHOP
Entity type:Organization
Organization Name:BERNSTEIN, HILLIKER, HARTZELL OPTICAL SHOP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-966-5582
Mailing Address - Street 1:88 HARDEES DR
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-7062
Mailing Address - Country:US
Mailing Address - Phone:866-995-3937
Mailing Address - Fax:
Practice Address - Street 1:137 JPM RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9313
Practice Address - Country:US
Practice Address - Phone:570-523-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CENTER OF CENTRAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4684830003Medicare NSC