Provider Demographics
NPI:1790975647
Name:USLEMAN, BENJAMIN (OD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:USLEMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11103 WEST AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6803
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:6555 E SOUTHERN AVE
Practice Address - Street 2:#2410
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3718
Practice Address - Country:US
Practice Address - Phone:480-854-3468
Practice Address - Fax:480-985-7346
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist