Individual provider Active NPI

Benjamin D Klibanoff, OD

  • Optometrist
  • Pawtucket, RI
National Provider Identifier
1053611996
Registry record updated Apr 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CODTG00551 Issued in RI
Practice address
55 Broad St
Pawtucket, RI 02860-2023
Phone
(401) 723-3400
NPI assigned
Oct 26, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X CODTG00551 RI Primary
Optometrist 152W00000X 4822 MA

Addresses

Primary practice location

55 Broad St
Pawtucket, RI 02860-2023

Mailing address

55 Broad St
Pawtucket, RI 02860-2023
Phone (401) 723-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111021000255 RI Practitioner - Optometry 0446422232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Klibanoff Eye Associates, LTDGroup PAC ID 6002993045, 2 clinicians

Practice addresses (Care Compare)

55 Broad St
Pawtucket, RI 02860-2023
Phone (401) 723-3400

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4822MAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Klibanoff Eye Associates, LTD CurrentSince May 16, 2011 Accepting new patients

Locations

55 Broad St
Pawtucket, RI 02860
Phone (401) 723-3400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1053611996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 BROAD ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028602023",
            "telephone_number": "401-723-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 BROAD ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028602023",
            "telephone_number": "401-723-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLIBANOFF",
        "first_name": "BENJAMIN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-26",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "RI",
            "license": "CODTG00551",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4822",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

Verify at the official NPI Registry.