Provider Demographics
NPI:1083901219
Name:BENNER, ALEX J (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:J
Last Name:BENNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 N MAIN ST
Mailing Address - Street 2:BOX 399
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-1373
Mailing Address - Country:US
Mailing Address - Phone:712-263-2020
Mailing Address - Fax:712-263-4053
Practice Address - Street 1:210 S 17TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-2055
Practice Address - Country:US
Practice Address - Phone:402-426-2119
Practice Address - Fax:402-426-2120
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002518152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist