Provider Demographics
NPI:1467405381
Name:BENKUSKY, STEPHEN P (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:BENKUSKY
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 1:103 W EDEN ST
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1843
Mailing Address - Country:US
Mailing Address - Phone:252-748-2420
Mailing Address - Fax:242-482-8444
Practice Address - Street 1:103 W EDEN ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1843
Practice Address - Country:US
Practice Address - Phone:252-748-2420
Practice Address - Fax:252-482-8444
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU65565Medicare UPIN