Provider Demographics
NPI:1134106594
Name:BENEVENTO, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:BENEVENTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 TANGLEFOOT LANE
Mailing Address - Street 2:EYE SURGEONS ASSOCIATES PC
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1650
Mailing Address - Country:US
Mailing Address - Phone:563-323-2020
Mailing Address - Fax:563-328-5694
Practice Address - Street 1:777 TANGLEFOOT LANE
Practice Address - Street 2:EYE SURGEONS ASSOCIATES PC
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1650
Practice Address - Country:US
Practice Address - Phone:563-323-2020
Practice Address - Fax:563-328-5694
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-088865207W00000X
IA30004207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088865Medicaid
IA0060350OtherIA GROUP MEDICAID #
IL790730OtherIL GROUP MEDICARE #
IA26568OtherIA GROUP MEDICARE #
IA0114074Medicaid
ILL31836Medicare PIN
IA0060350OtherIA GROUP MEDICAID #
IA16578Medicare PIN