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General NPI Number Information
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NPI Number | 1720172661
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Entity Type | Individual
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Provider Name | BENJAMIN JA O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 1650 RESPONSE RD
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City | SACRAMENTO
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State | CA
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Zip | 95815-4807
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Country | US
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Telephone | 916-648-0222
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Fax | 916-648-0231
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Provider Business Mailing Address
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Address Line | 1680D E ROSEVILLE PKWY BLDG D UNIT 110
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City | ROSEVILLE
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State | CA
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Zip | 95661-3988
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Country | US
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Telephone | 916-797-3139
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Fax | 877-738-4262
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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 | 9014
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9014T
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License Number State | CA
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