BENJAMIN LEROY LIGHT OCULARIST APPRENTICE NPI 1447294483

NPI Information

NPI: 1447294483
Provider Name: BENJAMIN LEROY LIGHT, OCULARIST APPRENTICE
Classification: Technician/Technologist - 156FX1700X
Entity Type: Individual

Specialization: Ocularist

Address:
1318 W CANDLETREE DR
SUITE 3
PEORIA, IL
ZIP 61614
Phone: (309) 676-3663
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Benjamin Leroy Light, OCULARIST APPRENTICE is an ocularist technician technologist in Peoria, IL. Benjamin Leroy Light, OCULARIST APPRENTICE NPI is 1447294483. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1318 W CANDLETREE DR
SUITE 3
PEORIA, IL
ZIP 61614-508
Phone: (309) 676-3663
Fax: (309) 676-0359

The enumeration date for this NPI number is 6/16/2006 and was last updated on 5/9/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	156FX1700X	Technician/Technologist	Ocularist		ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	1268070001	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS
2	1268070001	MEDICARE NSC	ILLINOIS
3	1268070002	MEDICARE NSC	MISSOURI
4	1268070001	MEDICARE NSC	ARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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