Provider Demographics
NPI:1841502994
Name:GATES, BENJAMIN H (OD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:H
Last Name:GATES
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 1:8107 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5115
Mailing Address - Country:US
Mailing Address - Phone:804-330-2588
Mailing Address - Fax:804-330-4396
Practice Address - Street 1:8107 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5115
Practice Address - Country:US
Practice Address - Phone:804-330-2588
Practice Address - Fax:804-330-4396
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist