Individual
JEFFERY L. DIBENEDETTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2290 S RANGE AVE, DENHAM SPRINGS, LA 70726-5214
(225) 665-2019
(225) 665-2089
Mailing address
2290 S RANGE AVE, DENHAM SPRINGS, LA 70726-5214
(225) 665-2019
(225) 665-2089
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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