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NPI Code Detail

MEDICARE: BENJAMIN SALVATORE MANIACI OD

MEDICARE: BENJAMIN SALVATORE MANIACI OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4901004519MI

General Provider Information

NPI Number : 1740519941
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN SALVATORE MANIACI OD
Provider Business Mailing Address
First Line : 655 W 13 MILE RD
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-1850
Country : US
Telephone Number : 248-577-3659
Fax Number : 248-588-9320
Provider Business Practice Location Address
First Line : 35184 CENTRAL CITY PKWY
Second Line :
City : WESTLAND
State : MI
Zip : 48185-6215
Country : US
Telephone Number : 734-427-5200
Fax Number : 734-427-8136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2009
Last Update Date : 03/11/2014

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