Provider Demographics
NPI:1740519941
Name:MANIACI, BENJAMIN SALVATORE (OD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SALVATORE
Last Name:MANIACI
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 1:655 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1850
Mailing Address - Country:US
Mailing Address - Phone:248-577-3659
Mailing Address - Fax:248-588-9320
Practice Address - Street 1:35184 CENTRAL CITY PKWY
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-6215
Practice Address - Country:US
Practice Address - Phone:734-427-5200
Practice Address - Fax:734-427-8136
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist