Provider Demographics
NPI:1013947118
Name:BENES, SUSAN CARLETON (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CARLETON
Last Name:BENES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 NEIL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:262 NEIL AVE STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7309
Practice Address - Country:US
Practice Address - Phone:614-917-1292
Practice Address - Fax:614-917-1293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-6649207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BE0502281Medicare ID - Type Unspecified
C02165Medicare UPIN