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NPI Code Detail

MEDICARE: JAMIE A. BENNETT O.D.

MEDICARE: JAMIE A. BENNETT O.D.
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
1152W00000XOptometrist1189OK

General Provider Information

NPI Number : 1083800080
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE A. BENNETT O.D.
Provider Business Mailing Address
First Line : 401 E SILAS ST
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74003-3611
Country : US
Telephone Number : 918-336-4068
Fax Number :
Provider Business Practice Location Address
First Line : 401 E SILAS ST
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74003-3611
Country : US
Telephone Number : 918-336-4068
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2007
Last Update Date : 04/19/2012

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