Provider Demographics
NPI:1174700793
Name:STEVEN I BENCH OD, PC
Entity type:Organization
Organization Name:STEVEN I BENCH OD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:BENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-883-4747
Mailing Address - Street 1:324 W FERRY ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1957
Mailing Address - Country:US
Mailing Address - Phone:716-883-4747
Mailing Address - Fax:716-883-4764
Practice Address - Street 1:324 WEST FERRY STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1957
Practice Address - Country:US
Practice Address - Phone:716-883-4747
Practice Address - Fax:716-883-4764
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN I BENCH OD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYV003048 1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01914167Medicaid
0016317OtherGHI
000300163001OtherBLUE CROSS & BLUE SHIELD
00010231602OtherUNIVERA
410032830OtherMEDICARE PALMETTO RAILROAD
00010231602OtherUNIVERA
NY00631365Medicaid
410032830OtherMEDICARE PALMETTO RAILROAD