Provider Demographics
NPI:1609807890
Name:BENACCI, ALLISON MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:MARIE
Last Name:BENACCI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4524
Mailing Address - Country:US
Mailing Address - Phone:814-835-8258
Mailing Address - Fax:814-838-0104
Practice Address - Street 1:2640 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4524
Practice Address - Country:US
Practice Address - Phone:814-835-8258
Practice Address - Fax:814-838-0104
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013650360001Medicaid
PA1013650360002Medicaid
PA1013650360002Medicaid
PA1013650360001Medicaid
PA066548XZDMedicare PIN