Provider Demographics
NPI:1083608491
Name:BENOIT, DOUGLAS P (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:BENOIT
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 1:2 PILLSBURY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3502
Mailing Address - Country:US
Mailing Address - Phone:603-228-1104
Mailing Address - Fax:603-228-7061
Practice Address - Street 1:2 PILLSBURY ST STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3502
Practice Address - Country:US
Practice Address - Phone:603-228-1104
Practice Address - Fax:603-228-7061
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0434152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0214001001OtherCIGNA
NH0905184Y0NH01OtherANTHEM NH
NH99002291Medicaid
NH180027368OtherRAILROAD MEDICARE
NHT84772Medicare UPIN
NH99002291Medicaid
NHRE0289Medicare PIN