=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134261381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINDA BENNETT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 BELMONT ST
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02478-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-484-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 231 BELMONT ST
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02478-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-484-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LINDA BENNETT
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 617-484-1414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------