Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 7932TG | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 7392TG | TX |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 7392TG | TX |
N | 152WP0200X | Pediatric Optomitrist | 7392TG | TX |
N | 152WS0006X | Sports Vision | 7392TG | TX |
N | 152WV0400X | Optomitrist - Vision Therapist | 7392TG | TX |
N | 152WX0102X | Occupational Vision | 7392TG | TX |
NPI | 1336479724 |
---|---|
Provider Name | Kevin L Benham |
First Address | Buda, TX 78610 |
Second Address | Buda, TX 78610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2010 |
Last Update Date | 31/08/2012 |