Provider Demographics
NPI:1184649519
Name:BENDER, ERIC JASON (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JASON
Last Name:BENDER
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 1:17602 17TH ST
Mailing Address - Street 2:103
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1961
Mailing Address - Country:US
Mailing Address - Phone:714-832-1288
Mailing Address - Fax:
Practice Address - Street 1:17602 17TH ST
Practice Address - Street 2:103
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1961
Practice Address - Country:US
Practice Address - Phone:714-832-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11860T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01554Medicare UPIN
CA6231850001Medicare NSC