Provider Demographics
NPI:1306298724
Name:EMER, BENJAMIN (OD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:EMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 77TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-6027
Mailing Address - Country:US
Mailing Address - Phone:262-455-1513
Mailing Address - Fax:
Practice Address - Street 1:3612 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7230
Practice Address - Country:US
Practice Address - Phone:262-652-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI342835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist