Provider Demographics
NPI:1992781942
Name:BENOIT, PAUL VINCENT (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VINCENT
Last Name:BENOIT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1025 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3877
Mailing Address - Country:US
Mailing Address - Phone:413-733-5906
Mailing Address - Fax:413-732-4292
Practice Address - Street 1:359 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-3536
Practice Address - Country:US
Practice Address - Phone:413-584-8324
Practice Address - Fax:413-584-9459
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15714OtherBCBSMA
MA10544OtherHEALTH NEW ENGLAND
MAW15714OtherBCBSMA
MA188658Medicare ID - Type Unspecified