Provider Demographics
NPI:1295935575
Name:BELLEVUE VISION CO
Entity type:Organization
Organization Name:BELLEVUE VISION CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:NORONA
Authorized Official - Last Name:FABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-734-3344
Mailing Address - Street 1:568 LINCOLN AVE
Mailing Address - Street 2:PO BOX 41088
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3530
Mailing Address - Country:US
Mailing Address - Phone:412-734-3344
Mailing Address - Fax:412-734-3344
Practice Address - Street 1:568 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3530
Practice Address - Country:US
Practice Address - Phone:412-734-3344
Practice Address - Fax:412-734-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000002744332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015184000003Medicaid
PABE280369OtherBLUE CROSS
PA393046OtherNVA
PA0015184000003Medicaid