Provider Demographics
NPI:1437143708
Name:BENJAMIN, ROGER LAFE (OD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:LAFE
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NORTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-6022
Mailing Address - Country:US
Mailing Address - Phone:501-605-8038
Mailing Address - Fax:
Practice Address - Street 1:314 MDOS/SGOAE
Practice Address - Street 2:1090 ARNOLD DRIVE
Practice Address - City:LITTLE ROCK AFB
Practice Address - State:AR
Practice Address - Zip Code:72099-0001
Practice Address - Country:US
Practice Address - Phone:501-987-8072
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3759T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist