Provider Demographics
NPI:1902860323
Name:BENNER, CHRISTIAN KEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:KEEN
Last Name:BENNER
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 1:316 HAY HILL CT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8239
Mailing Address - Country:US
Mailing Address - Phone:803-865-7763
Mailing Address - Fax:803-865-1451
Practice Address - Street 1:470-5 TOWN CENTER PLACE
Practice Address - Street 2:VILLAGE AT SANDHILL
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229
Practice Address - Country:US
Practice Address - Phone:803-865-1211
Practice Address - Fax:803-865-1451
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1333152W00000X
OH3329/T179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T47201Medicare UPIN