Provider Demographics
NPI:1952755878
Name:IDOCTORBEN LLC
Entity Type:Organization
Organization Name:IDOCTORBEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:BIN
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-892-4850
Mailing Address - Street 1:PO BOX 20902
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4069 POSTAL DR
Practice Address - Street 2:#20902
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6429
Practice Address - Country:US
Practice Address - Phone:540-892-4850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-17
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty