Provider Demographics
NPI:1700979796
Name:HENDIN, BENJAMIN I (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:I
Last Name:HENDIN
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 1:9150 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:PROFESSIONAL VISION STE 15
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:410-465-6166
Mailing Address - Fax:410-465-8898
Practice Address - Street 1:9150 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:STE 15
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:410-465-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11248579OtherCAQH
T59944Medicare UPIN
MD063L617AMedicare PIN