1972633543 NPI number — STEVEN I BENCH OD, PC

Table of content: (NPI 1972633543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972633543 NPI number — STEVEN I BENCH OD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN I BENCH OD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NIAGARA FALLS EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972633543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 BUFFALO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14303-1243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-284-9449
Provider Business Mailing Address Fax Number:
716-284-9467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 BUFFALO AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14303-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-284-9449
Provider Business Practice Location Address Fax Number:
716-284-9467
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRULISKY
Authorized Official First Name:
LORNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
716-284-9449

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  003048 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00631365 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003001633 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01914167 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00010231601 . This is a "UNIVERA COMMUNITY HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: J300094807 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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