Provider Demographics
NPI:1386774263
Name:BENEFIELD EYE CARE, PC
Entity type:Organization
Organization Name:BENEFIELD EYE CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-328-0972
Mailing Address - Street 1:11240 HIGHWAY 49 STE 300
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4151
Mailing Address - Country:US
Mailing Address - Phone:228-328-0972
Mailing Address - Fax:
Practice Address - Street 1:11240 HIGHWAY 49 STE 300
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4151
Practice Address - Country:US
Practice Address - Phone:228-328-0972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS012410156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB65688Medicare UPIN
NVC02721Medicare ID - Type Unspecified