Provider Demographics
NPI:1629255484
Name:WARD, BENJAMIN ALEXANDER (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALEXANDER
Last Name:WARD
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2620
Mailing Address - Country:US
Mailing Address - Phone:907-278-2020
Mailing Address - Fax:907-279-2020
Practice Address - Street 1:554 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2620
Practice Address - Country:US
Practice Address - Phone:907-278-2020
Practice Address - Fax:907-279-2020
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAAOO74156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOPO740Medicaid