Provider Demographics
NPI:1891833265
Name:BENEDICT, DENNIS HOWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:HOWARD
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 GIGI LN
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-2915
Mailing Address - Country:US
Mailing Address - Phone:865-622-8035
Mailing Address - Fax:
Practice Address - Street 1:156 GIGI LN
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-2915
Practice Address - Country:US
Practice Address - Phone:865-622-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002846152W00000X
TN2708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C86501Medicare PIN
MI0732770001Medicare NSC
MIP96837Medicare UPIN