Provider Demographics
NPI:1275947772
Name:BENITEZ, DAMARIS (OD)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1017
Mailing Address - Country:US
Mailing Address - Phone:305-262-7273
Mailing Address - Fax:
Practice Address - Street 1:5786 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5034
Practice Address - Country:US
Practice Address - Phone:786-253-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010782152WC0802X, 152WL0500X
FLOPC5159152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation