Provider Demographics
NPI:1841525524
Name:KOLLE, BENJAMIN FREDERICK (OD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:FREDERICK
Last Name:KOLLE
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 1:700 EASTGATE SOUTH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1583
Mailing Address - Country:US
Mailing Address - Phone:513-449-1318
Mailing Address - Fax:513-718-8610
Practice Address - Street 1:700 EASTGATE SOUTH DR STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245
Practice Address - Country:US
Practice Address - Phone:513-449-1318
Practice Address - Fax:513-718-8610
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist