Healthcare Provider Details

I. General information

NPI: 1205861846
Provider Name (Legal Business Name): KRISTIN L BENDER O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 HAYNES BRIDGE RD SUITE 710A
JOHNS CREEK GA
30022-8532
US

IV. Provider business mailing address

9925 HAYNES BRIDGE RD SUITE 710A
JOHNS CREEK GA
30022-8532
US

V. Phone/Fax

Practice location:
  • Phone: 770-740-2000
  • Fax:
Mailing address:
  • Phone: 770-740-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 001337
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT 001337
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT 001337
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberOPT 001337
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT 001337
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT 001337
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOPT 001337
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: