Provider Demographics
NPI:1508179151
Name:BENEDETTI, PAUL (LDO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BENEDETTI
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 E SUGARLOAF CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1485
Mailing Address - Country:US
Mailing Address - Phone:480-259-3306
Mailing Address - Fax:
Practice Address - Street 1:8050 E SUGARLOAF CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-1485
Practice Address - Country:US
Practice Address - Phone:480-259-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ534I156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician