Provider Demographics
NPI:1760640718
Name:BENJAMIN H STEIN OD INC
Entity Type:Organization
Organization Name:BENJAMIN H STEIN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SEC. TREAS.
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-569-2025
Mailing Address - Street 1:21500 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE #635
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5018
Mailing Address - Country:US
Mailing Address - Phone:248-569-2025
Mailing Address - Fax:248-569-5103
Practice Address - Street 1:21500 NORTHWESTERN HWY
Practice Address - Street 2:SUITE #635
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5018
Practice Address - Country:US
Practice Address - Phone:248-569-2025
Practice Address - Fax:248-569-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI004585433Medicaid
MI0844210001Medicare NSC
T33454Medicare UPIN