Basic Information
| Provider Information | |||||||||
| NPI: | 1346228665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNEHOFF | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6220 OLD DOBBIN LN | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210455812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438960710 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7550 TEAGUE RD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210761339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107998067 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 05/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046009555 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | TA2031 | MD | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.