Healthcare Provider Details

I. General information

NPI: 1992781942
Provider Name (Legal Business Name): PAUL VINCENT BENOIT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 RUSSELL ST
HADLEY MA
01035-3536
US

IV. Provider business mailing address

1025 WESTFIELD ST
WEST SPRINGFIELD MA
01089-3877
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-8324
  • Fax: 413-584-9459
Mailing address:
  • Phone: 413-733-5906
  • Fax: 413-732-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2786
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: