Provider Demographics
NPI:1598141939
Name:BENAVIDEZ, ANN ELIZABETH (OD)
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:ELIZABETH
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0160
Mailing Address - Country:US
Mailing Address - Phone:701-477-6111
Mailing Address - Fax:701-477-2500
Practice Address - Street 1:1300 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0160
Practice Address - Country:US
Practice Address - Phone:701-477-6111
Practice Address - Fax:701-477-2500
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist