Provider Demographics
NPI:1417945163
Name:POPILSKY, BENJAMIN WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WAYNE
Last Name:POPILSKY
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 1:7551 SOQUEL DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3815
Mailing Address - Country:US
Mailing Address - Phone:831-688-2020
Mailing Address - Fax:831-688-2036
Practice Address - Street 1:7551 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3815
Practice Address - Country:US
Practice Address - Phone:831-688-2020
Practice Address - Fax:831-688-2036
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9073TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU39801Medicare UPIN
CASD0090730Medicare ID - Type Unspecified