Provider Demographics
NPI:1528032448
Name:BENDER, JOHN T JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:BENDER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:201 W KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-4145
Mailing Address - Country:US
Mailing Address - Phone:334-347-6303
Mailing Address - Fax:
Practice Address - Street 1:1020-B BOLL WEEVIL CIR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2733
Practice Address - Country:US
Practice Address - Phone:334-347-2732
Practice Address - Fax:334-347-2732
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS671TA432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist