| Doctor Name: | BENJAMIN J FOGAL |
| NPI Number: | 1730174822 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OD |
| License Number: | 3019 |
| Business Practice Address: | 5842 Old Main St Suite 5 North Branch, MN - 550566687 |
| Business Phone Number: | 6576744735 |
| Business Fax Number: | 6516748002 |
| Mailing Address: | 9801 Dupont Ave S, Suite 425 BLOOMINGTON |
| State: | MN |
| Postal Code: | 554313100 |
| Phone Number: | 9525676092 |
| Fax Number: | 9525676176 |
| NPI Enumeration Date: | 09/14/2005 |
| NPI Last Update Date: | 03/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | 3019 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |