Provider Demographics
NPI:1669668653
Name:BENDER EYECARE
Entity Type:Organization
Organization Name:BENDER EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-781-7922
Mailing Address - Street 1:3434 E LAKE RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2401
Mailing Address - Country:US
Mailing Address - Phone:727-781-7922
Mailing Address - Fax:727-789-9859
Practice Address - Street 1:3434 E LAKE RD
Practice Address - Street 2:SUITE #3
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2401
Practice Address - Country:US
Practice Address - Phone:727-781-7922
Practice Address - Fax:727-789-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0594Medicare PIN