The Fishin' Buddies Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG000927 Issued in PA

Legal business name

THE FISHIN' BUDDIES INC.

Practice address

3650 Nazareth Pike
Bethlehem Village Shoppes
Bethlehem, PA 18020-1115

Phone

(610) 865-9900

Fax

(610) 865-3446

NPI assigned

Sep 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Matthew Alexander Nowik

Title

Manager

Phone

(610) 865-9900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crystal Vision Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213401600000",
    "number": "1891893483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 NAZARETH PIKE",
            "address_2": "BETHLEHEM VILLAGE SHOPPES",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180201115",
            "telephone_number": "610-865-9900",
            "fax_number": "610-865-3446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 NAZARETH PIKE",
            "address_2": "BETHLEHEM VILLAGE SHOPPES",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180201115",
            "telephone_number": "610-865-9900",
            "fax_number": "610-865-3446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FISHIN' BUDDIES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-06-14",
        "status": "A",
        "authorized_official_last_name": "NOWIK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "610-865-9900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA #",
            "identifier": "0070423700002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Bethlehem, PA
• Providers in Bethlehem, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.