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General NPI Number Information
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NPI Number | 1063740744
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Entity Type | Organization
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Legal Business Name | DR. JORGE A. BENAVENTE OPTOMETRIST PC
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 9175 CALUMET AVENUE
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City | MUNSTER
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State | IN
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Zip | 46321-2805
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Country | US
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Telephone | 219-836-7800
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Fax | 219-836-4806
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Provider Business Mailing Address
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Address Line | 9175 CALUMET AVE
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City | MUNSTER
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State | IN
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Zip | 46321-2805
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Country | US
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Telephone | 219-836-7800
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Fax | 219-836-4806
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE ADAME BENAVENTE
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Credential | OD
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Telephone | 219-836-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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