# JEFFERY L. DIBENEDETTO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1255360525
- **Gender:** Man
- **Credential:** O.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1321-456T | LA | Yes |
| 152WC0802X | Corneal and Contact Management Optometrist | 1321-456T | LA | — |
| 152WS0006X | Sports Vision Optometrist | 1321-456T | LA | — |

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 01/27/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1105350 | — | LA |