Provider Demographics
NPI:1306484589
Name:ALPHA OPTICAL BETHLEHEM, LLC
Entity type:Organization
Organization Name:ALPHA OPTICAL BETHLEHEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:267-481-2360
Mailing Address - Street 1:103 DICKENS CT
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1622
Mailing Address - Country:US
Mailing Address - Phone:267-481-2360
Mailing Address - Fax:
Practice Address - Street 1:4753 FREEMANSBURG AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5529
Practice Address - Country:US
Practice Address - Phone:610-866-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty