Organization
STEPHEN BENCHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN BENCHO SR. OD (OWNER)
(865) 475-2657
Entity
Organization
Contact information
Practice address
124 W OLD ANDREW JOHNSON HWY, JEFFERSON CITY, TN 37760-1945
(865) 475-2657
(865) 475-2657
Mailing address
PO BOX 327, JEFFERSON CITY, TN 37760-0327
(865) 475-2657
(865) 475-2657
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0656630001
PTAN
TN
05
—
3518221
—
TN
Enumeration date
02/22/2008
Last updated
03/28/2008
Update your record
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