Provider Demographics
NPI:1093323289
Name:CADE, BENJAMIN (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CADE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 RIGGINS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-9300
Mailing Address - Country:US
Mailing Address - Phone:859-420-2143
Mailing Address - Fax:
Practice Address - Street 1:404 JOHNSON ST STE A
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2479
Practice Address - Country:US
Practice Address - Phone:859-420-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1002156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician