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General NPI Number Information
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NPI Number | 1952755878
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Entity Type | Organization
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Legal Business Name | IDOCTORBEN LLC
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Dates
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Enumeration Date | 04/17/2016
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 4069 POSTAL DR #20902
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City | ROANOKE
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State | VA
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Zip | 24018-6429
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Country | US
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Telephone | 540-892-4850
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20902
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City | ROANOKE
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State | VA
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Zip | 24018-0091
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BENJAMIN BIN WANG
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Credential | OD
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Telephone | 540-892-4850
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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 | 0618002212
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License Number State | VA
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