Provider Demographics
NPI:1982009932
Name:BENJAMIN ONDERSMA OD LLC
Entity Type:Organization
Organization Name:BENJAMIN ONDERSMA OD LLC
Other - Org Name:EYE CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:ONDERSMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-510-5336
Mailing Address - Street 1:331 KILLIAN RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8926
Mailing Address - Country:US
Mailing Address - Phone:803-754-8370
Mailing Address - Fax:803-754-8371
Practice Address - Street 1:331 KILLIAN RD
Practice Address - Street 2:SUITE B2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8926
Practice Address - Country:US
Practice Address - Phone:803-754-8370
Practice Address - Fax:803-754-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1609302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization