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General NPI Number Information
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NPI Number | 1205065935
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Entity Type | Individual
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Provider Name | JACLYN ANNE BENZONI O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 2126 MERRICK MALL
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City | MERRICK
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State | NY
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Zip | 11566-3626
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Country | US
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Telephone | 516-546-3227
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Fax |
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Provider Business Mailing Address
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Address Line | 2126 MERRICK MALL
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City | MERRICK
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State | NY
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Zip | 11566-3626
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Country | US
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Telephone | 516-546-3227
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Fax | 516-546-4923
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV007403-1
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License Number State | NY
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