Provider Demographics
NPI:1972540029
Name:BENHOFF, WILLIAM A (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:BENHOFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-9552
Mailing Address - Country:US
Mailing Address - Phone:410-286-7185
Mailing Address - Fax:301-352-3568
Practice Address - Street 1:3327 SUPERIOR LN
Practice Address - Street 2:SUITE 206
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1922
Practice Address - Country:US
Practice Address - Phone:301-262-1210
Practice Address - Fax:301-352-3568
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA0564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC67500002OtherBLUE CROSS CAREFIRST
MD310726OtherMAMSI
DC67500002OtherBLUE CROSS CAREFIRST
T59974Medicare UPIN