Provider Demographics
NPI:1336352855
Name:BENZ, BETH A (OD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:BENZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2601
Mailing Address - Country:US
Mailing Address - Phone:805-641-9020
Mailing Address - Fax:805-641-9023
Practice Address - Street 1:2393 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2601
Practice Address - Country:US
Practice Address - Phone:805-641-9020
Practice Address - Fax:805-641-9023
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7912T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist