Provider Demographics
NPI:1275618068
Name:RICHARD H BENNINGER MD PC
Entity Type:Organization
Organization Name:RICHARD H BENNINGER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:BENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-459-3713
Mailing Address - Street 1:833 MICHIGAN ST NE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2578
Mailing Address - Country:US
Mailing Address - Phone:616-459-3713
Mailing Address - Fax:616-459-3716
Practice Address - Street 1:833 MICHIGAN ST NE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2578
Practice Address - Country:US
Practice Address - Phone:616-459-3713
Practice Address - Fax:616-459-3716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003291152W00000X
MI4301030073207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P47470Medicare PIN