Provider Demographics
NPI:1407942741
Name:DONALD, BEN B II (OD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:B
Last Name:DONALD
Suffix:II
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 1:403 N ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633
Mailing Address - Country:US
Mailing Address - Phone:903-694-2300
Mailing Address - Fax:903-694-2333
Practice Address - Street 1:403 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-1311
Practice Address - Country:US
Practice Address - Phone:903-694-2300
Practice Address - Fax:903-694-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4453TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0540180001OtherCIGNA GOVERNMENT SERVICES
TX019346801Medicaid
14867OtherSPECTERA PIN
924329OtherBLOCK VISION
TX00E42PMedicare PIN
924329OtherBLOCK VISION