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General NPI Number Information
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NPI Number | 1659640969
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Entity Type | Organization
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Legal Business Name | BENNETT FAMILY EYE CARE PC
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Dates
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Enumeration Date | 12/16/2011
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 231 BELMONT ST
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City | BELMONT
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State | MA
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Zip | 02478-3607
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Country | US
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Telephone | 617-484-1414
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Fax | 617-489-1957
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Provider Business Mailing Address
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Address Line | 231 BELMONT ST
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City | BELMONT
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State | MA
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Zip | 02478-3607
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Country | US
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Telephone | 617-484-1414
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Fax | 617-489-1957
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. REBECCA BENNETT MAIDA
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Credential | O.D.
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Telephone | 617-484-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2870
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4405
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4679
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License Number State | MA
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