Provider Demographics
NPI:1912085333
Name:BETZ OPHTHALMOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:BETZ OPHTHALMOLOGY ASSOCIATES, PC
Other - Org Name:BETZ OPHTHALMOLOGY ASSOCIATES, ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:BETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-524-4473
Mailing Address - Street 1:3 HOSPITAL DR STE 112
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9394
Mailing Address - Country:US
Mailing Address - Phone:570-524-4473
Mailing Address - Fax:570-524-4464
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:SUITE 112
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9362
Practice Address - Country:US
Practice Address - Phone:570-524-4473
Practice Address - Fax:570-524-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029851L261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB33208Medicare UPIN
PA457256Medicare ID - Type Unspecified