Provider Demographics
NPI:1881812709
Name:BENIGNO, JAMES B JR (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:BENIGNO
Suffix:JR
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:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-0687
Mailing Address - Country:US
Mailing Address - Phone:228-452-0830
Mailing Address - Fax:
Practice Address - Street 1:205 E SECOND ST
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-4422
Practice Address - Country:US
Practice Address - Phone:228-452-0830
Practice Address - Fax:228-452-0870
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880092Medicaid
MSU65700Medicare UPIN
MS410000159Medicare ID - Type UnspecifiedPROVIDER ID NUMBER