Provider Demographics
NPI:1295800274
Name:BENCH, STEVEN ISAAC (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ISAAC
Last Name:BENCH
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 1:17 MAPLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2848
Mailing Address - Country:US
Mailing Address - Phone:716-837-9876
Mailing Address - Fax:
Practice Address - Street 1:324 W FERRY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1957
Practice Address - Country:US
Practice Address - Phone:716-883-4747
Practice Address - Fax:716-883-4764
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYV00-4882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01914167Medicaid
NY01914167Medicaid