Healthcare Provider Details

I. General information

NPI: 1972633543
Provider Name (Legal Business Name): STEVEN I BENCH OD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 BUFFALO AVE SUITE 206
NIAGARA FALLS NY
14303-1243
US

IV. Provider business mailing address

151 BUFFALO AVE
NIAGARA FALLS NY
14303-1243
US

V. Phone/Fax

Practice location:
  • Phone: 716-284-9449
  • Fax: 716-284-9467
Mailing address:
  • Phone: 716-284-9449
  • Fax: 716-284-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number003048
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: LORNA KRULISKY
Title or Position: OFFICE MANAGER
Credential:
Phone: 716-284-9449