Organization
BENSON VISION SOURCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS L MITCHELL O.D. (PRESIDENT)
(253) 859-1911
Entity
Organization
Contact information
Practice address
25022 104TH AVE SE STE D, KENT, WA 98030-2822
(253) 859-1911
(253) 859-5084
Mailing address
25022 104TH AVE SE STE D, KENT, WA 98030-2822
(253) 859-1911
(253) 859-5084
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003501
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2026748
—
WA
Enumeration date
03/01/2007
Last updated
11/26/2012
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