Individual
DR. KYLE STEPHEN BENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7 PORTLAND FARMS RD, SCARBOROUGH, ME 04074-5301
(207) 883-2809
Mailing address
PO BOX 7487, PORTLAND, ME 04112-7487
(207) 883-2809
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT905
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433381199
—
ME
Enumeration date
09/16/2008
Last updated
01/20/2012
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