Provider Demographics
NPI:1063460103
Name:ROWE, BENJAMIN (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:ROWE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4217
Mailing Address - Country:US
Mailing Address - Phone:215-345-4186
Mailing Address - Fax:215-345-4196
Practice Address - Street 1:16 W STATE ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4217
Practice Address - Country:US
Practice Address - Phone:215-345-4186
Practice Address - Fax:215-345-4196
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001113152W00000X
NJ27TO00124800152W00000X
NJ27OA00585300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96805Medicare UPIN