Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 35-04-6649 | OH |
NPI | 1013947118 |
---|---|
Provider Name | Susan Carleton Benes |
First Address | Columbus, OH 43215-7309 |
Second Address | Columbus, OH 43215-7309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 17/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C02165 | (02) |