Provider Demographics
NPI:1922421627
Name:BENJAMIN EYE CARE ASSOCIATES
Entity Type:Organization
Organization Name:BENJAMIN EYE CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST O.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:BINH
Authorized Official - Middle Name:D
Authorized Official - Last Name:THAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:267-519-7550
Mailing Address - Street 1:3930 ARBOR TRACE DR
Mailing Address - Street 2:UNIT K
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-6729
Mailing Address - Country:US
Mailing Address - Phone:267-519-7550
Mailing Address - Fax:
Practice Address - Street 1:3930 ARBOR TRACE DR
Practice Address - Street 2:UNIT K
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-6729
Practice Address - Country:US
Practice Address - Phone:267-519-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002887302R00000X
FLOPC5017302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization