Provider Demographics
NPI:1861183808
Name:BENJAMIN GATES OD PLLC
Entity type:Organization
Organization Name:BENJAMIN GATES OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:GATES
Authorized Official - Suffix:I
Authorized Official - Credentials:OD
Authorized Official - Phone:804-955-9519
Mailing Address - Street 1:5401 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2629
Mailing Address - Country:US
Mailing Address - Phone:804-288-1012
Mailing Address - Fax:
Practice Address - Street 1:5401 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2629
Practice Address - Country:US
Practice Address - Phone:804-288-1012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty