Provider Demographics
NPI:1245490648
Name:BEN-NISSAN I CARE CORP
Entity type:Organization
Organization Name:BEN-NISSAN I CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN-NISSAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-538-1201
Mailing Address - Street 1:3491 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4426
Mailing Address - Country:US
Mailing Address - Phone:305-538-1201
Mailing Address - Fax:305-531-9703
Practice Address - Street 1:3491 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4426
Practice Address - Country:US
Practice Address - Phone:305-538-1201
Practice Address - Fax:305-531-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1211280001Medicare NSC