Individual
DR. BENJAMIN DAVID DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
300 N STATE ST, HARRISVILLE, MI 48740-9693
(989) 724-7440
(989) 724-7531
Mailing address
300 N STATE ST, HARRISVILLE, MI 48740-9693
(989) 724-7440
(989) 724-7531
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004764
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0Z10008
BLUE CROSS BLUE SHIELD PIN
MI
Enumeration date
06/20/2013
Last updated
07/14/2023
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