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Individual
JEFFERY L. DIBENEDETTO
Active
Individual
JEFFERY L. DIBENEDETTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1321-456T
LA
152WC0802X
Corneal and Contact Management Optometrist
1321-456T
LA
152WS0006X
Sports Vision Optometrist
1321-456T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1105350
—
LA
Enumeration date
06/30/2006
Last updated
01/27/2012
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