Doctor Name: | MARK DAVID BENTON |
NPI Number: | 1043527245 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | C 3586 |
Business Practice Address: | 1 Atwell Rd Eye Clinic Cooperstown, NY - 133261301 |
Business Phone Number: | 6075473142 |
Business Fax Number: | 6075473192 |
Mailing Address: | 1 Atwell Rd, Eye Clinic COOPERSTOWN |
State: | NY |
Postal Code: | 133261301 |
Phone Number: | 6075473142 |
Fax Number: | 6075473192 |
NPI Enumeration Date: | 09/09/2010 |
NPI Last Update Date: | 09/09/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | C 3586 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |