Individual
DR. NICHOLAS G BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3250 MARLETTE CIRCLE, SOUTH LAKE TAHOE, CA 96156
(530) 542-0480
Mailing address
P.O. BOX 173, 3250 MARLETTE CIRCLE, SOUTH LAKE TAHOE, CA 96156
(530) 542-0480
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ATE20131
CA
Other
Enumeration date
04/14/2010
Last updated
04/14/2010
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