Provider Demographics
NPI:1811388515
Name:BENSON, MATTHEW (LDO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PORTER SQ
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1431
Mailing Address - Country:US
Mailing Address - Phone:617-864-7005
Mailing Address - Fax:617-864-3250
Practice Address - Street 1:1 PORTER SQ
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1431
Practice Address - Country:US
Practice Address - Phone:617-864-7005
Practice Address - Fax:617-864-3250
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6243156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter