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General NPI Number Information
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NPI Number | 1467405381
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Entity Type | Individual
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Provider Name | STEPHEN P BENKUSKY OD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 103 W EDEN ST
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City | EDENTON
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State | NC
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Zip | 27932-1843
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Country | US
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Telephone | 252-748-2420
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Fax | 252-482-8444
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Provider Business Mailing Address
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Address Line | 103 W EDEN ST
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City | EDENTON
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State | NC
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Zip | 27932-1843
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Country | US
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Telephone | 252-748-2420
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Fax | 242-482-8444
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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 | 1613
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License Number State | NC
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