Provider Demographics
NPI:1073588869
Name:BENJAMIN, PATRICIA C (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:C
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:2019 HIGHLAND AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3801
Practice Address - Country:US
Practice Address - Phone:205-328-2020
Practice Address - Fax:205-918-9096
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-102-TA-098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058546Medicaid
ALR102-TA-098OtherAL BOARD OF OPTOMETRY
ALR102-TA-098OtherAL BOARD OF OPTOMETRY
ALMB0175439OtherDEA
ALR102-TA-098OtherAL BOARD OF OPTOMETRY