Individual
KIMBERLY R BENIGNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1720A MEDICAL PARK DR, SUITE 330, BILOXI, MS 39532-2129
(228) 396-5185
(228) 396-5186
Mailing address
1720A MEDICAL PARK DR, SUITE 330, BILOXI, MS 39532-2129
(228) 396-5185
(228) 396-5186
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
622
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0880093
—
MS
01
—
94170
TPA #
MS
Enumeration date
07/11/2006
Last updated
07/08/2007
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