Healthcare Provider Details

I. General information

NPI: 1134106594
Provider Name (Legal Business Name): WILLIAM JOSEPH BENEVENTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 TANGLEFOOT LANE EYE SURGEONS ASSOCIATES PC
BETTENDORF IA
52722-1650
US

IV. Provider business mailing address

777 TANGLEFOOT LANE EYE SURGEONS ASSOCIATES PC
BETTENDORF IA
52722-1650
US

V. Phone/Fax

Practice location:
  • Phone: 563-323-2020
  • Fax: 563-328-5694
Mailing address:
  • Phone: 563-323-2020
  • Fax: 563-328-5694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-088865
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number30004
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: