Provider Demographics
NPI:1164424941
Name:BENKEL, JEROME MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:MARTIN
Last Name:BENKEL
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 1:2762 WILMINGTON PIKE
Mailing Address - Street 2:8100 E CAMELBACK RD #155
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-313-3934
Mailing Address - Fax:937-294-3064
Practice Address - Street 1:8100 E CAMELBACK RD
Practice Address - Street 2:#155
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2773
Practice Address - Country:US
Practice Address - Phone:480-313-3934
Practice Address - Fax:937-294-3064
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2755152W00000X
AZ1394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT46105Medicare UPIN