Provider Demographics
NPI:1609929215
Name:KOHN, BENJAMIN J (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:KOHN
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 1:2121 41ST AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2056
Mailing Address - Country:US
Mailing Address - Phone:831-476-7744
Mailing Address - Fax:
Practice Address - Street 1:2121 41ST AVE
Practice Address - Street 2:STE 108
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2056
Practice Address - Country:US
Practice Address - Phone:831-476-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8521T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy