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NPI Code Detail

MEDICARE: BENNETT OPTOMETRY LLC

MEDICARE: BENNETT OPTOMETRY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1265022552
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENNETT OPTOMETRY LLC
Provider Business Mailing Address
First Line : PO BOX 208177
Second Line :
City : DALLAS
State : TX
Zip : 75320-8177
Country : US
Telephone Number : 636-200-4393
Fax Number : 636-527-0766
Provider Business Practice Location Address
First Line : 330 W LAKE LANSING RD
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-8527
Country : US
Telephone Number : 636-200-4393
Fax Number : 636-527-0766
Authorized Official
Title or Position : CMO
Name : JAMES WACHTER
Credential :
Telephone Number : 636-200-4393
Provider Enumeration Date : 01/21/2021
Last Update Date : 03/03/2021

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Directions to “BENNETT OPTOMETRY LLC ” Practice Location

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