Provider Demographics
NPI:1851335061
Name:BENITZ, BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:BENITZ
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 1:5961 S LOS ALTOS PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2500
Mailing Address - Country:US
Mailing Address - Phone:775-359-2020
Mailing Address - Fax:775-359-2676
Practice Address - Street 1:1987 N CARSON ST
Practice Address - Street 2:SUITE #5
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1218
Practice Address - Country:US
Practice Address - Phone:775-883-2015
Practice Address - Fax:775-883-5805
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4682730001Medicare NSC
NVV37565Medicare PIN
NVU87876Medicare UPIN