Waldo, Benjamin Lee
Waldo, Benjamin Lee is an individual health care provider with primary practice located at 14201 Ne 20Th Ave Ste A102 , Vancouver WA 98686-6411. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Optometrist. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Waldo, Benjamin Lee can be contacted via phone (360) 574-6030.Contact Information
Primary practice address
14201 Ne 20Th Ave Ste A102
Vancouver WA 98686-6411
Phone: (360) 574-6030
Fax: (360) 574-4116
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | WV1020OD | West Virginia |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 60022188 OD | Washington |
Profile Details
| NPI number | 1194780361 |
|---|---|
| LBN Legal business name | Waldo, Benjamin Lee |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 19th, 2006 |
| Last updated | Jan 24th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194780361 | NPPES |
| West Virginia | MEDICAID | 00112571000 | |
| West Virginia | MEDICAID | 0150205000 |
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