Provider Demographics
NPI:1407039597
Name:BENJAMIN C. YANOFSKY, OD, PLC
Entity Type:Organization
Organization Name:BENJAMIN C. YANOFSKY, OD, PLC
Other - Org Name:ADVANCED EYECARE OF ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:YANOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-833-1434
Mailing Address - Street 1:1809 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8235
Mailing Address - Country:US
Mailing Address - Phone:480-833-1434
Mailing Address - Fax:
Practice Address - Street 1:1809 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8235
Practice Address - Country:US
Practice Address - Phone:480-833-1434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01434152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120830Medicare PIN
AZUO1952Medicare UPIN