Provider Demographics
NPI:1659405058
Name:SETH BERNSTEIN OD AND LISA BENHAM OD INC
Entity Type:Organization
Organization Name:SETH BERNSTEIN OD AND LISA BENHAM OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-736-2020
Mailing Address - Street 1:2791 GREEN RIVER RD
Mailing Address - Street 2:#106
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7426
Mailing Address - Country:US
Mailing Address - Phone:951-736-2020
Mailing Address - Fax:951-736-2002
Practice Address - Street 1:2791 GREEN RIVER RD
Practice Address - Street 2:#106
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7426
Practice Address - Country:US
Practice Address - Phone:951-736-2020
Practice Address - Fax:951-736-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR 680152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04755ZMedicare PIN