Provider Demographics
NPI:1104011485
Name:WHEELER, BENJAMIN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:WHEELER
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 1:428 W 48TH ST
Mailing Address - Street 2:APT 1 RE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036
Mailing Address - Country:US
Mailing Address - Phone:615-430-6758
Mailing Address - Fax:718-364-7300
Practice Address - Street 1:138 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5408
Practice Address - Country:US
Practice Address - Phone:615-430-6758
Practice Address - Fax:718-364-7300
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007387152W00000X
TN2780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist