Healthcare Provider Details

I. General information

NPI: 1821097056
Provider Name (Legal Business Name): BRETT G BENCE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 MERIDIAN AVE N SUITE 370
SEATTLE WA
98133-9451
US

IV. Provider business mailing address

PO BOX 6989 MAIL STOP 18913
PORTLAND OR
97228-6989
US

V. Phone/Fax

Practice location:
  • Phone: 206-528-6000
  • Fax: 206-528-0014
Mailing address:
  • Phone: 206-858-7000
  • Fax: 206-858-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00001584
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: