MEDICARE: KIMBERLY R BENIGNO 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	622	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	94170	OTHER	MS	TPA #

General Provider Information

NPI Number	:	1558395806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY R BENIGNO O.D.

Provider Business Mailing Address
First Line	:	1720A MEDICAL PARK DR
Second Line	:	SUITE 330
City	:	BILOXI
State	:	MS
Zip	:	39532-2129
Country	:	US
Telephone Number	:	228-396-5185
Fax Number	:	228-396-5186

Provider Business Practice Location Address
First Line	:	1720A MEDICAL PARK DR
Second Line	:	SUITE 330
City	:	BILOXI
State	:	MS
Zip	:	39532-2129
Country	:	US
Telephone Number	:	228-396-5185
Fax Number	:	228-396-5186

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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