Healthcare Provider Details

I. General information

NPI: 1912759309
Provider Name (Legal Business Name): BENJAMIN ALEXANDER FRIEDMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 14TH AVE SE
ALBANY OR
97322-6956
US

IV. Provider business mailing address

5498 BARNSTEAD CIR
LAKE WORTH FL
33463-6673
US

V. Phone/Fax

Practice location:
  • Phone: 541-928-1667
  • Fax:
Mailing address:
  • Phone: 561-870-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4720
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: