Provider Demographics
NPI:1720216484
Name:WANG, BENJAMIN BIN (OD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BIN
Last Name:WANG
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5049 VALLEY VIEW BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2074
Mailing Address - Country:US
Mailing Address - Phone:540-362-7565
Mailing Address - Fax:540-563-0441
Practice Address - Street 1:5049 VALLEY VIEW BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2074
Practice Address - Country:US
Practice Address - Phone:540-362-7565
Practice Address - Fax:540-563-0441
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002212152W00000X, 152W00000X
ALR-213-TA-931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017663010002Medicaid