Provider Demographics
NPI:1235544826
Name:BENSON, ANDREW (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BENSON
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 1:5489 N XENIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3870
Mailing Address - Country:US
Mailing Address - Phone:720-295-5356
Mailing Address - Fax:720-263-9142
Practice Address - Street 1:5489 N XENIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238
Practice Address - Country:US
Practice Address - Phone:720-295-5356
Practice Address - Fax:720-263-9142
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003058152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist