Provider Demographics
NPI:1821097056
Name:BENCE, BRETT G (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:G
Last Name:BENCE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6989
Mailing Address - Street 2:MAIL STOP 18913
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-6989
Mailing Address - Country:US
Mailing Address - Phone:206-858-7000
Mailing Address - Fax:206-858-7050
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:SUITE 370
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-528-6000
Practice Address - Fax:206-528-0014
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA116075OtherL & I
WA2001337Medicaid
WA000100394Medicare ID - Type UnspecifiedSEATTLE CLINIC
WA001148881Medicare ID - Type UnspecifiedSMOKEY POINT CLINIC
WA2001337Medicaid