MEDICARE: GINA MARIE DEBENEDETTO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	008035	NY

General Provider Information

NPI Number	:	1275973349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE DEBENEDETTO O.D.

Provider Business Mailing Address
First Line	:	4600 E 2ND ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-4224
Country	:	US
Telephone Number	:	307-237-3362
Fax Number	:	307-237-3475

Provider Business Practice Location Address
First Line	:	4600 E 2ND ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-4224
Country	:	US
Telephone Number	:	307-237-3362
Fax Number	:	307-237-3475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	10/28/2025

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