Provider Demographics
NPI:1376522862
Name:MT BETHEL EYE CARE P C
Entity type:Organization
Organization Name:MT BETHEL EYE CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-897-5911
Mailing Address - Street 1:9 MOUNT BETHEL PLZ
Mailing Address - Street 2:
Mailing Address - City:MOUNT BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:18343-5212
Mailing Address - Country:US
Mailing Address - Phone:570-897-5911
Mailing Address - Fax:570-897-5908
Practice Address - Street 1:9 MOUNT BETHEL PLZ
Practice Address - Street 2:
Practice Address - City:MOUNT BETHEL
Practice Address - State:PA
Practice Address - Zip Code:18343-5212
Practice Address - Country:US
Practice Address - Phone:570-897-5911
Practice Address - Fax:570-897-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000111152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02095801OtherKEYSTONE
PA02886800OtherCAPITAL BLUE CROSS
PA751252OtherKEYSTONE
PA02095801OtherKEYSTONE SENIOR BLUE
PA02095801OtherCAPITAL BLUE CROSS
PA751252OtherHIGHMARK BLUE SHIELD
PA02886800OtherKEYSTONE SENIOR BLUE
PA751252OtherKEYSTONE SENIOR BLUE
PA02886800OtherKEYSTONE
PA1253981001OtherCIGNA
PA396396OtherNATIONAL VISION ADM.
PA5708975911OtherVISION SERVICE PLAN
PAG521252OtherAMERIHEALTH ADM.
PA176529873OtherAMERIHEALTH ADM.
PA465212OtherAETNA
PA465212OtherAETNA
PA751252OtherHIGHMARK BLUE SHIELD
PA396396OtherNATIONAL VISION ADM.
PA465212OtherAETNA
PA176529873OtherAMERIHEALTH ADM.
PA0727860001Medicare NSC
PA751252Medicare PIN