Provider Demographics
NPI:1851479083
Name:BENSON, LAURA LOUISE (LDO)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LOUISE
Last Name:BENSON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 NW 27TH CIR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8072
Mailing Address - Country:US
Mailing Address - Phone:360-910-6844
Mailing Address - Fax:
Practice Address - Street 1:2252 NW 27TH CIR
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8072
Practice Address - Country:US
Practice Address - Phone:360-910-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1901156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens