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General NPI Number Information
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NPI Number | 1306298724
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Entity Type | Individual
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Provider Name | BENJAMIN EMER O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2016
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Last Update Date | 07/09/2016
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Provider Practice Location Address
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Address Line | 3612 ROOSEVELT RD
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City | KENOSHA
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State | WI
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Zip | 53142-7230
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Country | US
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Telephone | 262-652-1689
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Fax |
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Provider Business Mailing Address
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Address Line | 505 77TH ST
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City | KENOSHA
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State | WI
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Zip | 53143-6027
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Country | US
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Telephone | 262-455-1513
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Fax |
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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 | 342835
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License Number State | WI
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