Individual
DR. HERNAN G. BENAVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
138 E BROAD ST, EUFAULA, AL 36027-2024
(334) 687-2545
(334) 687-6491
Mailing address
PO BOX 635, EUFAULA, AL 36072-0635
(334) 687-2545
(334) 687-6491
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-387-TA-013
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059471
—
AL
05
—
000267495A
—
GA
01
—
51059471
BCBS
AL
01
—
59471
TRICARE
AL
Enumeration date
12/15/2005
Last updated
07/06/2009
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