Eugene George Benedict, OD
Individual provider Active NPI Optometrist · Buchanan, MI
NPI 1003848433 · NPPES record last updated Jan 14, 2013
Key facts
- NPI
- 1003848433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901002243 (MI)
- Practice address
- 802 E Front St
Suite 2
Buchanan, MI 49107-1499 - Phone
- (269) 695-9011
- Fax
- (269) 695-2251
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18001440A | IN | MD | Optometrist |
| 4901002243 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Vision Center Inc. | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002243 | MI | Yes |
| Optometrist | 152W00000X | 18001440A | IN |
Addresses
Primary practice location
802 E Front St
Suite 2
Buchanan, MI 49107-1499
Mailing address
802 E Front St
Suite 2
Buchanan, MI 49107-1499
Phone (269) 695-9011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5014457 | Medicaid | MI |
Other providers in Buchanan, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.