Provider Demographics
NPI:1902949985
Name:BENCAL
Entity Type:Organization
Organization Name:BENCAL
Other - Org Name:MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCHIS
Authorized Official - Phone:559-732-5905
Mailing Address - Street 1:4006 S DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9476
Mailing Address - Country:US
Mailing Address - Phone:559-732-5905
Mailing Address - Fax:559-627-4378
Practice Address - Street 1:4006 S DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9476
Practice Address - Country:US
Practice Address - Phone:559-732-5905
Practice Address - Fax:559-627-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA4000237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ67408ZOtherBLUE SHIELD
CAHA0039580Medicaid
CAZZZ67409ZOtherBLUE SHIELD
CAHA0039581Medicaid
CAZZZ67406ZOtherBLUE SHIELD