Individual
MOLLY BENCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
105 NORTHRIDGE DR, NEW LONDON, WI 54961-2703
(920) 982-3711
Mailing address
PO BOX 230, NEW LONDON, WI 54961-0230
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3455-35
WI
Other
Enumeration date
06/07/2017
Last updated
02/05/2020
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