Provider Demographics
NPI:1508024415
Name:EBRAHIM, BENYAMIN Y (MD)
Entity Type:Individual
Prefix:
First Name:BENYAMIN
Middle Name:Y
Last Name:EBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BELL RD
Mailing Address - Street 2:ANTIOCH EYE CARE CENTER, PHYSICIAN & SURGEON, PLLC
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2002
Mailing Address - Country:US
Mailing Address - Phone:615-361-7266
Mailing Address - Fax:
Practice Address - Street 1:522 BELL RD
Practice Address - Street 2:ANTIOCH EYE CARE CENTER, PHYSICIAN & SURGEON, PLLC
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2002
Practice Address - Country:US
Practice Address - Phone:615-361-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49780207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531656Medicaid
TN1531656Medicaid