Healthcare Provider Details

I. General information

NPI: 1760640718
Provider Name (Legal Business Name): BENJAMIN H STEIN OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21500 NORTHWESTERN HWY SUITE #635
SOUTHFIELD MI
48075-5018
US

IV. Provider business mailing address

21500 NORTHWESTERN HWY SUITE #635
SOUTHFIELD MI
48075-5018
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-2025
  • Fax: 248-569-5103
Mailing address:
  • Phone: 248-569-2025
  • Fax: 248-569-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. STUART ALAN STEIN
Title or Position: PRESIDENT/SEC. TREAS.
Credential:
Phone: 248-569-2025