Provider Demographics
NPI:1538296447
Name:BENSON, RICHARD H (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:BENSON
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 1:304 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-2425
Mailing Address - Country:US
Mailing Address - Phone:401-726-1747
Mailing Address - Fax:401-724-9857
Practice Address - Street 1:304 FRONT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-2425
Practice Address - Country:US
Practice Address - Phone:401-726-1747
Practice Address - Fax:401-724-9857
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI00003092OtherBCBS BLUECHIP
RI0000009826-7OtherBCBS OF RI
RI2783OtherNEIGHBORHOOD PLAN OF RI
RI050343239OtherTRICARE
RI9009826Medicaid
RI0000009826-7OtherBCBS OF RI
RI9009826Medicaid
RI0329860002Medicare NSC