Provider Demographics
NPI:1720288632
Name:MONTGOMERY EYE PHYSICIANS
Entity Type:Organization
Organization Name:MONTGOMERY EYE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDERS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENKWITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-271-3804
Mailing Address - Street 1:478 MCQUEEN SMITH RD S
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5631
Mailing Address - Country:US
Mailing Address - Phone:334-365-5643
Mailing Address - Fax:334-365-8079
Practice Address - Street 1:2752 ZELDA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2694
Practice Address - Country:US
Practice Address - Phone:334-271-3804
Practice Address - Fax:334-270-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H445Medicare PIN